Higher Medicaid reimbursements for routine office visits linked to more cancer screening tests

Medicaid reimbursements for office visits to the doctor and for cancer screening tests vary substantially from state to state. New research in the journal Cancer finds that Medicaid recipients are more likely to receive cancer screening tests when their doctors receive higher reimbursements for routine office visits. In contrast, increased reimbursement rates for screening tests do not have a uniform effect on whether Medicaid beneficiaries get screened.

"Increasing reimbursement levels for screening tests may expand the supply of facilities (e.g., laboratories, imaging facilities) providing services for Medicaid beneficiaries," the study notes, "but increasing payments for office visits may increase access to and/or the supply of providers ordering the tests."

Previous studies have found that compared with Medicare recipients or people with private health insurance, Medicaid enrollees are less likely to be screened for cancer and, if diagnosed with cancer, are more likely to be diagnosed at later, harder to treat stages.

The study compared data on cancer screening (including colonoscopy, mammography, fecal occult blood tests and Pap tests) among Medicaid recipients with state Medicaid reimbursement rates for doctor's office visits and for screening tests. In states that reimbursed more for office visits, the researchers found a seven percent increase in recipients' odds of having a colonoscopy, a nine percent increase in the odds of having a fecal occult blood test and a two percent increase in the odds of having a Pap test or mammogram.

In contrast, Medicaid reimbursement rates for screening tests did not consistently show an association with getting screened. For example, a 20 percent increase in reimbursement for a colonoscopy was associated with a 1.6 percent increase in the odds of receiving one, while an increased reimbursement for film mammography was associated with a 5.4 percent decrease in the odds of having one done. "We didn't know if one or both [types of reimbursement rates] would have the main effect on the Medicaid beneficiary being screened," said Michael Halpern, PhD, MD, senior fellow with RTI International in Washington, DC, and the study's lead author. "It turned out that it was reimbursement for doctor visits that were the crucial step."

Provisions in the Patient Protection and Affordable Care Act (ACA) are intended to temporarily increase Medicaid reimbursements for primary care office visits. "Increasing the office visit reimbursement will probably allow primary care physicians to see more Medicaid patients and increase access to preventive services like cancer screening," Halpern said.

Elizabeth Ward, PhD, national vice president for intramural research with the American Cancer Society in Atlanta, said primary care visits are a crucial first step in fighting cancer.

"The most important part of cancer screening is to have regular access to primary care so that you get referred for screening tests," she said. When reimbursement rates are higher, more doctors will accept Medicaid insurance, so people are more likely to receive primary care, she added.

In addition to increasing reimbursement rates, Ward noted, states that accepted the Medicaid expansion will experience fewer recipients cycling in and out of the Medicaid program because of losing eligibility. She added that the ACA increases the availability and affordability of private insurance, which helps people stay continuously insured if they lose Medicaid eligibility.