Are Delays in Melanoma Surgery Associated With Medical Insurance Type?

Surgical delays in patients with melanoma vary according to their type of insurance: private insurance, Medicare fee for service, or Medicaid, according to results published in JAMA Dermatology.

A population-based cohort of 7629 patients who had received a diagnosis of melanoma between 2004 and 2011 was analyzed from the North Carolina Cancer Registry. Data from the registry was linked to administrative claims from Medicare, Medicaid, and private insurance. Patients with a diagnosis of stage 0 to III melanoma who were continuously enrolled in insurance plans from 1 month prior to the month of melanoma diagnosis to 12 months following the diagnosis were included in the study.

Surgical delay was defined as definitive surgical excision that occurred >6 weeks after a diagnosis of melanoma. Of the 7629 study participants identified, 4210 (55%) were women, and mean patient age was 64±15. The investigators identified 7629 participants (55% women; mean age, 64 years) of whom 3667 (48%) had private insurance, 3631 (48%) had Medicare, and 331 (4%) had Medicaid. Privately insured patients were significantly less likely to experience a delay in surgery (14%) compared with Medicare (17%) and Medicaid patients (24%; all P <.001).

Following demographic adjustment, risk for surgical delay was significantly increased in patients with Medicaid vs patients with private insurance (risk ratio [RR] 1.36; 95% CI, 1.09-1.70; P =.007). Delays were significantly more likely to be experienced by nonwhite patients (RR 1.38; 95% CI, 1.02-1.87; P =.04). Moreover, surgical delays were significantly less likely to occur if the physician performing the surgery (RR 0.82; 95% CI, 0.72-0.93; P =.002) or the diagnosing clinician (RR 0.81; 95% CI, 0.71-0.93; P =.002) was a dermatologist vs a nondermatologist.

The researchers concluded that surgical delays among patients with melanoma, although common, occur less frequently in patients who are diagnosed or surgically treated by a dermatologist. The highest rate of surgical delays were experienced by Medicaid patients. Reduction in delays in melanoma surgery might be accomplished through improved access to specialty care and multidisciplinary coordination.

Reference

Adamson AS, Zhou L, Baggett CD, Thomas NE, Meyer A-M. Association of delays in surgery for melanoma with insurance type [published online October 4, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.3338