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 “States tend to vary in their reimbursement rates for different
types of medical care services; some states may have low
reimbursements for certain services and higher reimbursements for
others,” said lead author Dr. Michael T. Halpern of the Division of
Health Services and Social Policy Research at RTI International at
Washington, D.C.
Medicaid, a health insurance program for low-income individuals, is
jointly funded by the federal government and the individual states.
Each state establishes its own coverage and reimbursement policies.
Unexpectedly, states’ reimbursement rates for specific screening
tests weren’t always associated with an increase in screening rates,
Halpern and his team found.
There is no reason to believe that reimbursing more for a certain
test would lead to that test being used less, so there’s probably
something else going on to explain that relationship, which was
specifically true for Pap tests, Halpern told Reuters Health by
email.
Researchers analyzed Medicaid data from 2007 for 46 states and the
District of Columbia.
In states with higher payments for office visits, cancer screenings
were more common. But higher payments for the screenings themselves
did not always mean the screenings were performed more often,
according to results published in the journal Cancer.
Nationwide, the median Medicaid reimbursement for an office visit is
$37. (In other words, half the states pay doctors less than that.)
The median Medicaid reimbursement was $24 for a Pap test, which can
detect early cervical cancer, and $271 for a colonoscopy.
These tests are all recommended for the age group of the people in
the study, but since some of the tests are not recommended yearly
and the study only includes data from 2007, it was not clear whether
the Medicaid beneficiaries were receiving guideline-based screening,
Halpern said.
State by state, when screening test reimbursement rose by 20
percent, the odds of receiving a colonoscopy increased by 1.6
percent, the odds of getting a Pap test decreased by 0.8 percent,
and a mammogram might be more or less likely depending on the type
and location of the screening order.
But when reimbursement for an office visit rose by 20 percent, so
did screening rates, by 2 to 8 percent.
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“Many primary care physicians do not accept Medicaid patients or are
able to provide care only to limited numbers of Medicaid
beneficiaries, potentially due to low reimbursements for office
visits,” Halpern said. “By increasing Medicaid reimbursements for
primary care physician office visits, more physicians may be able to
provide care for Medicaid beneficiaries, thus increasing their
likelihood of receive cancer screenings.”
For screenings like colonoscopy and mammography, the primary care
doctor refers the patient to another provider for those tests, so
the amount Medicaid reimburses for the tests generally doesn’t have
a financial benefit for the referring physician, he said.
“The finding with higher Medicaid office fees is noteworthy, because
it means that higher fees open physicians’ doors to Medicaid
patients and that is the first step to getting patients the care
they need,” said Stephen Zuckerman, senior fellow and co-director of
the Health Policy Center of the Urban Institute. “Cancer screening
is only on part of that.”
Doctors’ time is limited, and economic incentives matter to them,
Zuckerman told Reuters Health by email.
“In a system with many payers, that means that it makes sense for
physicians to see patients for whom they receive better compensation
before they see other patients,” he said.
Fees are not the only incentives in scheduling patients, but they do
play an important role, he said.
“Since office visit fees have the most consistent relationship to
receipt of cancer screening, it would be important to make sure
those fees are sufficient to get Medicaid patients appropriate
access to primary care services,” Zuckerman said.
SOURCE: http://bit.ly/1tOc4l9
Cancer, online August 25, 2014.
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