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Phillip M Williford

Publications and source records attributed to Phillip M Williford.

16 recordsLinked to original sources
PubMed2006

Treatment patterns and cost of nonmelanoma skin cancer management.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common form of cancer in the United States, more common than all other cancers combined. The factors that affect the cost of skin cancer management are not well defined. OBJECTIVE: The objective was to estimate cost of episodes of NMSC care and the factors that impact those costs. DESIGN: Medicare Current Beneficiary Survey (MCBS) data from 1999 to 2000 were used to assess costs of episodes of NMSC care. MCBS estimates of the number of episodes occurring in three service settings (physician's office, outpatient/ambulatory surgical center, or hospital) and demographics were obtained. RESULTS: There were 497 episodes of care in 372 patients. Half the episodes were treated by dermatologists, and two-thirds were managed in physicians' offices. The mean episode cost for management in the office setting was 500 dollars (SD, +/- 487 dollars), and costs were higher when the episodes were treated in either the ambulatory surgical center or the hospital settings, 935 dollars (SD, +/- 456 dollars) and 4,345 dollars (SD, +/- 4939 dollars), respectively. CONCLUSION: With the rising incidence and cost of NMSC to Medicare, it is increasingly important to preserve the low-cost management of this disease. Maintaining care of NMSC in the office-based setting is more cost-efficient than utilizing ambulatory surgical centers or hospital operating rooms.

Aged↗
PubMed2005

Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer.

BACKGROUND: Development of actinic keratoses (AK) involves some of the same processes as nonmelanoma skin cancer and may serve as a marker for overall increased risk of skin cancer. OBJECTIVE: The objective of this study was to examine the risk of developing skin cancer in an elderly population with and without AK. METHODS: This was a retrospective observational study. Data from the 1992-1998 Medicare Current Beneficiary Study were used in the analyses. RESULTS: Multivariate analysis showed that the risk (odds ratio [OR]) of developing nonmelanoma or melanoma was increased more than sixfold (p < or = .0001) in patients with AK. An increased risk of skin cancer was found in whites (OR 4.3; p < or = .01) and increased age by year (OR 1.04; p < or = .01). Women were less likely to develop skin cancer (OR 0.58; p < or = .01). CONCLUSION: Using data from a nationally representive sample of the Medicare population, this study demonstrates that elders with AK are a population at high risk of developing cutaneous cancer.

Aged↗
PubMed2005

Interpretation of dermatopathology specimens is within the standard of care of dermatology practice.

BACKGROUND: Laws have been passed in New York, California, New Jersey, Nevada, Louisiana, and Rhode Island and were recently tabled in South Carolina to prohibit providers from billing for pathology services provided by other physicians. The Ohio proposal included language stating that only board-certified pathologists be able to directly bill for anatomic pathology services. Dermatologists, however, have extensive training in dermatopathology and frequently bill anatomic pathology codes. OBJECTIVE: To determine if interpretation of cutaneous pathology falls within the standard of care of dermatology practice. DESIGN: We used Medicare part A and B claims data from the Medicare Current Beneficiary Survey, 1992 to 2000. We identified surgical pathology claims by Current Procedural Terminology (CPT) code 88305 and those related to skin disease by the associated International Classification of Disease, 9th Revision (ICD-9), code. Weights were applied to obtain nationally representative estimates. The number of physicians in each specialty was obtained from American Medical Association estimates. RESULTS: Pathologists, independent laboratories and group practices, and dermatologists submitted 59%, 26%, and 13% of total claims, respectively. For skin-related diagnoses, pathologists, dermatologists, and independent laboratories and group practices performed 34.5%, 31.2%, and 32.8% of cases, respectively. Assuming that independent laboratory and group practice claims were performed entirely by pathologists, dermatologists and pathologists submitted 1,047 and 1,154 cases/physician, respectively. CONCLUSION: Dermatologists have extensive training in dermatopathology and interpret a large proportion of cutaneous specimens. Interpretation of anatomic pathology, in particular, skin and subcutaneous pathology specimens, falls within the scope of dermatology practice.

Adult↗
PubMed2004

The safety of office-based surgery: review of recent literature from several disciplines.

OBJECTIVE: To review recent literature pertaining to adverse outcomes and mortality associated with office-based surgery. STUDY SELECTION: Representative articles from the general and plastic surgery, medical, health regulatory, and dermatology literature. DATA EXTRACTION: Information regarding which surgical treatments should be performed, which specialties should perform them, what level of anesthesia is appropriate, and who should administer it was assessed, with particular attention to issues of patient safety. CONCLUSIONS: Office-based surgery is safe and cost-effective. We caution against attempts to prohibit or severely restrict this important aspect of medical care.

Ambulatory Surgical Procedures↗
PubMed2004

Patients spend more time with the physician for excision of a malignant skin lesion than for excision of a benign skin lesion.

BACKGROUND: Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures. OBJECTIVE: To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors. METHOD: We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed. RESULTS: The mean time spent with the physician at visits for excision of benign lesions was 22.9 +/- 1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0 +/- 1.7, 30% longer (p<0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race. CONCLUSION: Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted.

Episode of Care↗
PubMed2004

Why are there differences in the perceived safety of office-based surgery?

BACKGROUND: Office-based surgery has become an important method of health-care delivery, but there is controversy about its safety and which practitioners should perform it. Several states have already or are preparing to enact legislation regulating office-based surgery. OBJECTIVE: The objective was to discuss recent literature pertaining to the safety of office surgery and to discuss reasons why there are perceived differences in its safety. METHODS: The pertinent literature is reviewed. Results. The majority of studies suggest that office surgery is safe. A recent study that found to the contrary may have methodologic flaws. CONCLUSION: The medical and legislative community should seek to scientifically examine office surgery. Overregulation or loss of office surgery would have a tremendous impact on the management of skin cancers and the delivery of quality cosmetic and laser surgery.

Ambulatory Surgical Procedures↗
PubMed2003

Coding multiple diagnoses for patient visits at which procedures were performed: no evidence for abuse by physicians.

BACKGROUND: A problem area in the reimbursement of physicians is the office visit at which both procedures and evaluation/management services are performed. Insurers are concerned that frequent reporting of diagnoses unrelated to procedures may represent an abuse of the claims process. OBJECTIVE: To determine the frequency of secondary diagnoses that are present at visits at which procedures are performed and to compare the frequency with that reported in Medicare claims. METHOD: The 1998 and 1999 National Ambulatory Medical Care Survey (NAMCS) data were used to provide data unrelated to claims for payment. The results were compared with Medicare claims data from the 1998 to 1999 Medicare Current Beneficiary Survey. NAMCS visits were limited to patients who were 65 year old or greater to limit the analysis to the Medicare population. RESULTS: In the NAMCS dataset, 52% of the visits for actinic keratoses at which a procedure was performed were associated with multiple diagnoses. Similarly, in the Medicare Current Beneficiary Survey dataset, 52% of these visits had multiple diagnoses listed. CONCLUSION: The frequency of visits with multiple diagnoses is the same in both administrative claims and epidemiologic survey databases. There is no evidence for widespread abusive coding by physicians. It is incumbent on payers to respect the integrity of the coding system in order to assure fair reimbursement for physician services.

Ambulatory Surgical Procedures↗
PubMed2003

Nonmelanoma skin cancer: an episode of care management approach.

BACKGROUND: The incidence of nonmelanoma skin cancers (NMSCs) was estimated at 1.3-million cases for the year 2000 and is on the rise. It is the most common form of cancer in the United States, more common than all other cancers combined. To determine the contributors to the cost of NMSC care, an episode of care of NMSC needed to be defined. OBJECTIVE: To define and validate an episode of NMSC care. DESIGN: Using survey and Medicare part A and part B claims data of the Medicare Current Beneficiary Survey (MCBS), 1992 to 1995, an algorithm was created to define an episode of care for the diagnosis and treatment of an NMSC. MCBS estimates of the number of episodes occurring in three service settings (physician's office, outpatient/ambulatory surgical center, or hospital) and demographics were compared to data from independent datasets, including the National Ambulatory Medical Care Survey (NAMCS, 1995), the National Survey of Ambulatory Surgery (NSAS, 1994 to 1996), and the National Hospital Discharge Survey (NHDS, 1992 to 1997). RESULTS: Pathology claims for NMSC diagnosis served as the indicator of NMSC episodes. The procedures, office visits, and tests that resulted in and from the pathology specimen were identified. The sum of the associated charges to Medicare or Medicare payments for all identified claims equaled the total cost of the episode of NMSC care. For example, these preliminary results demonstrated significant differences between medical and surgical subspecialties. CONCLUSION: This study defined and validated a model of an episode of NMSC care. This model's initial results serve as preliminary data for the design of further studies addressing the differences between specialties and settings. The use of this model will allow identification of factors that determine the cost of NMSC treatment and that are associated with higher cost of care.

Algorithms↗
PubMed2003

Frequency of seborrheic keratosis biopsies in the United States: a benchmark of skin lesion care quality and cost effectiveness.

BACKGROUND: Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. OBJECTIVE: To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. METHODS: Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." RESULTS: Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost (9 million US dollars) to Medicare was generated from high-intensity management compared with 15% by dermatologists (6 million US dollars). CONCLUSION: There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care.

Benchmarking↗
PubMed2003

Skin cancer is among the most costly of all cancers to treat for the Medicare population.

BACKGROUND: Compared with other malignancies, nonmelanoma skin cancer (NMSC) is associated with much less morbidity and mortality. NMSC is, however, far more common than other malignancies. The cost of managing NMSC has not been assessed. OBJECTIVE: The purpose of our study was to determine where the cost of NMSC management ranks among other cancers in the Medicare population. DESIGN: Representative Medicare part A and B claims data were obtained from the Medicare current beneficiary survey, 1992 to 1995. Claims associated with cancer costs were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Weights were applied to obtain nationally representative estimates. RESULTS: Average Medicare expenditure on cancer management was $13 billion per year. The 5 most costly cancers to Medicare were lung and bronchus, prostate, colon and rectum, breast, and NMSC. The mean annual cost per patient using Medicare for all cancers was $17,094. Malignancies of lung and bronchus, colon and rectum, breast, and prostate were 11 to 19 times more costly per affected patient than NMSC. CONCLUSION: In addition to classifying cancers by number of cases and number of deaths, the financial impact of treatment can also be used to prioritize different malignancies. Such a scheme ranks NMSC far higher than would death statistics. In light of its already high and rising incidence, the cost of NMSC care to Medicare is likely to increase. However, to maintain the cost-effective management of NMSC, it is essential to preserve the current low per-patient cost of its management.

Aged↗
PubMed2003

Surgical treatment of nonmelanoma skin cancer in the Medicare population.

BACKGROUND: Nonmelanoma skin cancer (NMSC) is the most common malignancy of white populations. Different surgical treatment options can be used to treat these tumors, depending on the tumor characteristics and setting. OBJECTIVE: To determine how frequently different specialists use the different types of surgical options available for the treatment of NMSC using a 1998-1999 sample of Medicare claims data. METHODS: Episodes of care of NMSC were identified by pathology claims with a diagnosis of NMSC. The surgical interventions performed within 7 days before the pathologic diagnosis of NMSC were then analyzed. The numbers of patients and the variety of surgical treatments were categorized by specialty to include dermatology, general surgery, and plastic surgery. RESULTS: Dermatologists managed 82% of the NMSC episodes. Dermatologists used a wider range of different treatment options than other specialists and performed 90% of the biopsies, 56% of the excisions, 95% of the destructions, and 100% of the Mohs micrographic surgeries for NMSC. CONCLUSIONS: Dermatologists identify and manage most of the NMSC in the United States and offer patients a broad range of surgical options. The use by dermatologists of office-based surgical methods not commonly used by other specialists may partially explain previous findings of better NMSC outcome by dermatologists. The low level of use of specific surgical options by some specialists may indicate the need for greater training/exposure to these methods.

Humans↗
PubMed2002

Characteristics of office-based physician visits for cutaneous fungal infections. an analysis of 1990 to 1994 National Ambulatory Medical Care Survey Data.

To our knowledge, visits in the ambulatory setting due to cutaneous fungal infections have not been recently characterized. To provide descriptive epidemiology on ambulatory cutaneous fungal infection visits, we analyzed office-based physician visits for cutaneous fungal infections recorded in the National Ambulatory Medical Care Survey (NAMCS) from 1990 to 1994. The International Classification of Diseases (ICD-9) was used to define the cutaneous fungal infections. Sampling weights were applied to achieve the nationally representative estimates. From 1990 to 1994, an estimated 21.6 million physician office visits at an estimated cost of $216 million/y (office visit plus medication costs) were made for cutaneous fungal infection diagnoses. The total cost of office visits (without medication costs) was approximately $116 million/y. The total cost of the top 5 medications was approximately $68 million/y. According to an analysis of visits per physician specialist, dermatologists had the largest proportion of visits for cutaneous fungal infections. The cost associated with the diagnosis and management of cutaneous fungal infections is significant. Of all the physician specialists, dermatologists treated the most cutaneous fungal infections.

Adolescent↗
PubMedDate not supplied

Tanning and skin cancer.

Skin cancer is a large and growing problem in the United States. Sun and other ultraviolet (UV) light exposures play a key role in the development of skin cancer. Pediatricians can play an important role in counseling patients and are in a position to help educate children and their families about skin cancer. The purpose of this review is to familiarize pediatricians with the magnitude of the skin cancer problem and the evidence that ultraviolet light exposure, particularly indoor tanning, contributes to this problem. We reviewed the literature on ultraviolet light and skin cancer (based on a MEDLINE search of articles using the headings "ultraviolet light" and "skin cancer") and found that skin cancer is the most rapidly growing cause of cancer deaths in the United State. There is strong epidemiologic evidence for the relationship between UV exposure and nonmelanoma skin cancer and growing evidence for the relationship between indoor tanning and melanoma. We recommend that pediatricians counsel children and their parents about UV protection. Measures such as use of sunscreen and hats for outdoor play, both at home and in school, should be encouraged.

Adolescent↗
PubMedDate not supplied

Cutaneous ulcerative lichen planus exhibiting pathergy, response to acitretin.

While ulcerative lichen planus is a common diagnosis when involving the mucosa, it is uncommonly found on the cutaneous surface. Cutaneous ulcerative lichen planus is usually found on the palmar or plantar surfaces and has only rarely been described elsewhere. We describe a case of cutaneous ulcerative lichen planus involving the pretibia and exhibiting pathergy, which to our knowledge has not been previously reported. We also describe successful treatment with oral acitretin in conjunction with topical and intralesional corticosteroids.

Acitretin↗