September 04, 2014
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Higher Medicaid reimbursement linked to increased cancer screening rates

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State-specific increased Medicaid reimbursement for office visits was significantly associated with a greater likelihood for breast, cervical and colorectal cancer screenings, according to recent findings.

“Few studies have examined how state-specific differences in Medicaid policies might affect use of preventive care services, particularly for early detection of cancer,” Michael Halpern, MD, PhD, of RTI International, said in a press release. “Our study was able to compare differences in cancer screening for Medicaid beneficiaries in almost all states, providing a broad, national picture of the effects of state-level Medicaid policies on receipt of these critical medical care services among a large group of underserved individuals.”

Michael Halpern

In the cross-sectional regression analysis, Halpern and colleagues evaluated Medicaid Analytic Extract (MAX) claims and enrollment data from 2007. The study sample consisted of individuals in 46 states aged 21 to 64 years, who had been enrolled in Medicaid for at least 4 months. The researchers hypothesized that the following state-specific factors might influence cancer screening: income and financial assets, preventive care physician copayments, and the schedule of eligibility renewal (12 months after initial enrollment vs. less than 12 months after initial enrollment).

The study’s primary outcome of interest was receipt of a colonoscopy, mammogram, and fecal occult blood test (FOBT) or Pap test. The researchers used CPT codes and ICD-9 procedure codes to determine the rates of these screening tests.

Additionally, they noted the eligibility of members of the Medicaid patient sample for each procedure, which was as follows: Pap test, 2,136,511 patients; mammogram, 792,470 patients; colonoscopy, 769,729 patients; and FOBT, 753,868 patients.

Halpern and colleagues found that among the Medicaid beneficiaries, state-specific increases in screening test reimbursement showed both positive and negative correlations with the likelihood of screening uptake. Conversely, there was a positive association between increased reimbursements for office visits and the likelihood of undergoing all screening tests.

The odds ratios included: colonoscopy (OR=1.07; 95% CI, 1.06-1.08), FOBT (OR=1.09; 95% CI, 1.08-1.1), Pap test (OR=1.02; 95% CI, 1.02-1.03) and mammogram (OR=1.02; 95% CI, 1.02-1.03). Regarding the impact of other Medicaid policies in specific states, fluctuations across screening tests were noted.

“Due to multiple factors, including Health Care Reform and decreased state budgets, many states are changing their Medicaid policies, including how much health care providers are paid and who is allowed to enroll,” Halpern said in the release. “Our findings can help state health care decision makers and policy leaders to develop new Medicaid policies that aid low income individuals in receiving recommended cancer screenings.”

Disclosure: The researchers report no relevant financial disclosures.