D76. Sociodemographic Drivers of Reconstructive Care Following Mohs Micrographic Surgery

PURPOSE: Mohs surgeons have increasingly chosen to perform post-Mohs Micrographic Surgery (MMS) reconstruction over referring to plastic surgery (PRS). However, the involvement of PRS may improve care quality, particularly in complex cases. This study aimed to identify drivers of reconstructive care following MMS. METHODS: The Massachusetts All-Payer Claims Database was queried for MMS cases for head and neck skin cancers from 2016-2020. Claims were reviewed to identify referrals. Predictors of PRS referrals were identified by multivariable regression analysis. RESULTS: From 2016-2020, 70,308 patients underwent a single episode of MMS, and 5,090 (7.24%) were referred to PRS. Referrals decreased from 2016 (8.07%) to 2020 (6.38%). Melanoma (9.09%) and melanoma-in-situ (10.00%) were most likely to be referred. Publicly insured patients (OR:1.08) had higher odds of PRS referral. Median reconstructive payments from private insurers for physician services were greater for both MMS ($194.32) and PRS ($231.48) compared to public insurers ($53.57, $169.61). CONCLUSION: Consistent with nation-wide analyses, PRS referrals following MMS in Massachusetts are decreasing. Public insurance status independently predicts referrals, suggesting that financial motivators could influence physician decision-making. Such factors may impact the quality of reconstructive care available to patients with skin cancer.