Medicaid Reimbursement Rate Has Direct Impact on Cancer Screening Rates

Rosemary Frei, MSc

October 2014, Vol 5 , No 8 - Economics of Cancer Care


Although increasing the reimbursement rate for cancer screening tests does not consistently improve the likelihood of Medicaid beneficiaries being screened for cancer, raising the rate of reimbursement for office visits does consistently increase the likelihood that they will be screened for cancer, including breast or prostate cancer, according to results of a new analysis of Medicaid claims and enrollment data (Halpern MT, et al. Cancer. 2014 Aug 25. Epub ahead of print).

In this analysis, a 20% increase in office visit reimbursement was associated with increases in the likelihood of Medicaid beneficiaries being screened for cancer, ranging from a 2.2% increase for mammography to an 8.7% increase for fecal occult blood testing (FOBT).

“Our study confirmed what other studies have shown in other areas of medicine: that the office visit is really the key step for Medicaid enrollees, especially, I believe…the primary care provider office visit, because this is the gatekeeper for other services,” lead investigator Michael T. Halpern, MD, PhD, MPH, Health Services Research, RTI International, Washington, DC, told Value-Based Cancer Care.

“By increasing reimbursement, that presumably would lead to either more physicians participating in the program, or physicians who are already participating being able to accept more Medicaid beneficiaries, and through that improve access to care and overall health outcomes for this underserved population,” Dr Halpern said.

Study Details
The investigators used 2007 Medicaid data for individuals (aged 21-64 years) who had been enrolled in a fee-for-service Medicaid plan for at least 4 months. People who lived in Arizona, New Mexico, Nevada, and Maine were excluded from the analysis because of lack of availability or access to complete data.

In 2007, within the age- and sex-appropriate samples, only 26% of patients received a Pap test; 20% received film or digital mammography; 6% received a colonoscopy; and only 4% received an FOBT. The national Medicaid median screening test reimbursement rate was lowest for a Pap test ($24); the others ranged from $30.51 for a facility film mammography to $270.94 for a colonoscopy.

When the Medicaid reimbursement rate was increased by 20% of the national median reimbursement for that screening test/office visit, the odds ratios for receiving a colonoscopy increased by 1.6%, and the likelihood of receiving a Pap smear was reduced by 0.8%.

The odds of receiving mammography increased under all reimbursement arrangements, except for film mammography at facilities, which showed a 5.4% decrease in the odds of receiving a mammography.

Not having financial asset tests for Medicaid eligibility was generally associated with an increased likelihood of receiving cancer screening tests, whereas requiring office visit copayments was generally associated with a decreased likelihood.

Increased reimbursement for office visits was consistently associated with an increased likelihood of screening for all the tests examined. A 20% increase in office visit reimbursement was associated with increased likelihood of receiving all 4 screening modalities—8.7% for FOBT, 6.9% for colonoscopy, 2.3% for Pap test, and 2.2% for mammography.