This document details the methodology for the Melanoma Resection measure and should be reviewed along with the Melanoma Resection Measure Codes List file, which contains the medical codes used in constructing the measure.
Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures.
The Melanoma Resection episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for patients who undergo an excision procedure to remove a cutaneous melanoma during the performance period. The measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.
In the United States, the average age when melanoma is diagnosed is 65, with incidence and melanoma-specific mortality increasing with age and peaking in those aged 65-74 years.3 It is estimated that over 196,000 cases of melanoma will be newly diagnosed in 2020. Furthermore, it is estimated that the total annual treatment costs for melanoma are $3.3 billion annually, a figure that is anticipated to continue to rise due to the increasing incidence of melanoma.4 The Melanoma Resection episode-based cost measure was recommended for development by an expert clinician committee—the Dermatologic Disease Management Clinical Subcommittee— because of its impact in terms of patient population and clinician coverage, and the opportunity for incentivizing cost-effective, high-quality clinical care in this area. Based on the initial recommendations from the Clinical Subcommittee, the subsequent measure-specific clinician expert workgroup provided extensive, detailed input on this measure.
The cost measure numerator is the sum of the ratio of observed to expected5 payment standardized cost to Medicare for all Melanoma Resection episodes attributed to a clinician. This sum is then multiplied by the national average observed episode cost to generate a dollar figure.
The cost measure denominator is the total number of episodes from the Melanoma Resection episode group attributed to a clinician.
The Melanoma Resection cost measure uses the following data sources:
- Medicare Parts A and B claims data from the Common Working File (CWF)
- Enrollment Data Base (EDB)
- Long Term Care Minimum Data Set (LTC MDS)6
Methodologically, the Melanoma Resection cost measure can be triggered based on claims data from ambulatory surgical centers (ASC), ambulatory/office-based care, and hospital outpatient department (HOPD).
The cohort for this cost measure consists of patients who are Medicare beneficiaries enrolled in Medicare fee-for-service and who undergo an excision procedure to remove a cutaneous melanoma that triggers a Melanoma Resection episode.
The cohort for this cost measure is also further refined by the definition of the episode group and measure-specific exclusions (see Appendix A).
1 Claim payments are standardized to account for differences in Medicare payments for the same service(s) across Medicare providers. Payment standardized costs remove the effect of differences in Medicare payment among health care providers that are the result of differences in regional health care provider expenses measured by hospital wage indexes and geographic price cost indexes (GPCIs) or other payment adjustments such as those for teaching hospitals. For more information, please refer to the “CMS Price (Payment) Standardization - Basics" and “CMS Price (Payment) Standardization - Detailed Methods” documents posted on the CMS Price (Payment) Standardization Overview page. (https://www.resdac.org/articles/cms-price-payment-standardization-overview)
2 Cost is defined by allowed amounts on Medicare claims data, which include both Medicare trust fund payments and any applicable beneficiary deductible and coinsurance amounts. Claims data from Medicare Parts A and B are used to construct the episode-based cost measures.
3 Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
4 “Skin Cancer Facts & Statistics: What You Need to Know “Skin Cancer Facts and Statistics. Skin Cancer Foundation. Accessed May 1, 2020. https://www.skincancer.org/skin-cancer-information/skincancer-facts/
5 Expected costs refer to costs predicted by the risk adjustment model. For more information on expected costs and risk adjustment, please refer to Section A.5.
6 For information on how LTC MDS data are used in risk adjustment, please refer to Section A.5.