Medicaid Payments For Breast Cancer Radiation Vary Widely

MedicalResearch.com Interview with:

Ankit Agarwal, MD, MBAPGY-3, Radiation Oncology ResidentUNC Health Care

Dr. Agarwal

Ankit Agarwal, MD, MBA
PGY-3, Radiation Oncology Resident
UNC Health Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medicaid provides vital health insurance for millions of mostly low income Americans throughout the United States. However, it is well known that patients with Medicaid have worse clinical outcomes than patients with private insurance or Medicare insurance. Part of the reason for this may be due to difficulties with access to care, in part due to the traditionally very low payments in the Medicaid system.

We found that Medicaid payment rates for a standard course of breast cancer radiation treatment can vary over fivefold (ranging from $2,945 to $15,218) 

MedicalResearch.com: What should readers take away from your report?

Response: There is considerable variation in payment rates for radiation oncology by Medicaid across the United States that far outstrip the underlying differences in practice expenses. These variations can have important implications for access to care. Narrowing the gap between Medicaid and Medicare payments, especially in the lowest paying states, is an important policy tool to ensure more timely access to cancer care for patients. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research can investigate if rates of radiation therapy utilization vary between states depending on underlying payment rates. Does the utilization of radiation therapy for prostate cancer or breast conservation therapy (as compared to mastectomy) for patients with early stage breast cancer vary as a function of the underlying reimbursement rates? We don’t know the answer to these questions yet, but answering these questions will allow physicians and policymakers to come up with more sensible solutions to inequalities in critical cancer care services.

Citation:

Int J Radiat Oncol Biol Phys. 2019 Mar 27. pii: S0360-3016(19)30257-3. doi: 10.1016/j.ijrobp.2019.02.031. [Epub ahead of print]

Variations in Medicaid Payment Rates for Radiation Oncology.

Agarwal A1, Peterson J2, Hoyle LM3, Marks LB3.

https://www.ncbinlm.nih.gov/pubmed/30944071

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