Medicaid payouts for office visits may influence cancer screening: study

By Kathryn Doyle

By Kathryn Doyle

NEW YORK (Reuters Health) – In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study.

“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.

“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: Cancer, online August 25, 2014.