How Medicaid Reimbursements Impact Cancer Screening Rates

Physicians who receive higher reimbursements for routine office visits are more likely to perform cancer screening tests on Medicaid beneficiaries, according to a new study in Cancer.

With Medicaid beneficiaries less likely to be screened for cancer—despite the service being covered by state Medicaid programs—the researchers set out to determine if state Medicaid eligibility and reimbursement policies affect whether or not beneficiaries receive breast, cervical, and colon cancer screening.

The researchers analyzed 2007 Medicaid data of individuals aged 21-64 years old from 46 states and the District of Columbia and determined that increased reimbursements for office visits was associated with an increased chance of the patient receiving screening tests. However, increases in screening test reimbursement had mixed associations with the likelihood of receiving tests.

"We didn't know if one or both [types of reimbursement rates] would have the main effect on the Medicaid beneficiary being screened," Michael Halpern, PhD, MD, senior fellow with RTI International in Washington, DC, and the study's lead author, told the Center for Advancing Health’s Health Behavior News Service. "It turned out that it was reimbursement for doctor visits that were the crucial step."

Increasing office visit reimbursements would not only increase the likelihood of being screened, but increase the number of Medicaid beneficiaries that primary care physicians can see, Halpern added.

The study compared data on colonoscopy, mammography, fecal occult blood tests, and Papanicolaou. In states that reimbursed more for office visits, the odds of Medicaid beneficiaries having a colonoscopy increased 7%, the odds of a fecal occult blood test increased 9%, and the odds of having a Papanicolaou test or mammography increased 2%.

In contrast, a 20% increase in reimbursement for colonoscopy was only associated with a 1.6% increase in the odds of receiving one and increased reimbursement for mammography was actually associated with a 5.4% decrease.