The Price We Pay: What Broke American Health Care--and How to Fix It

by Marty Makary

Here’s where things get interesting. Mohs surgery typically takes one or two precise stages. On rare occasions, a third stage may be necessary. Surgeons get paid well for Mohs procedures. And it turns out that they get paid per stage. Cut a little extra here and there and you get a bigger paycheck, whether the extra cuts are necessary or not. As a surgeon, I was familiar with these types of financial “carrots” lying around the operating room. Albertini explained that over the last several years, the association’s leadership had heard multiple reports that some doctors appear to be doing the operation in too many stages. It may be that the doctors need further training. Or they could be motivated by money. Albertini proposed a pattern we could examine for the Improving Wisely project. We could look at the average number of stages each surgeon used during the procedures. We would see who was making the most cuts. “Most surgeons fall in a certain range,” Albertini told me. “But some are going to be way out there adding time and expense to the procedure and unnecessary surgery for patients.”