A new study has found a fivefold
difference in state-by-state Medicaid
reimbursement for radiation

Fivefold difference found in Medicaid reimbursements for radiotherapy

April 18, 2019
by John R. Fischer, Senior Reporter
Physicians in Delaware who perform standard-of-care radiotherapy for breast cancer can expect to receive up to $15,218 in Medicaid reimbursement, in contrast to those in New Hampshire who receive as low as $2,945 for the same procedure.

This is just one in a number of state-by-state variations when it comes to Medicaid recompensation, according to a new study, which asserts that such differences may increase existing disparities in access to healthcare for rural communities, which typically have higher Medicaid coverage rates compared to Metropolitan areas.

"In our study, we found that some state policymakers set competitive reimbursement rates for radiation oncology services while other states critically under fund those same services," Dr. Ankit Agarwal, first author of the study and a radiation oncology resident physician at the University of North Carolina at Chapel Hill, told HCB News. "This is likely due to some states recognizing problems with regards to access to care and willing to invest money to improve access - while other states simply do not have the money or the political will to do so."

Roughly 66 million low-income Americans are enrolled in Medicaid. Such patients often experience delays and disproportionate challenges in accessing the care they need, especially if living in states with low Medicaid fees. Previous studies and decades of research show that this can affect a number of healthcare essentials, from having a regular pediatric physician for children to providing preventative cancer screening services to Medicaid recipients.

Examining the 2017 Medicaid fee schedules of 48 states and the District of Columbia, the researchers made standard-of-care breast radiotherapy as the focus of their study and found a fivefold difference in average reimbursement, with the lowest in New Hampshire and the highest in Delaware. The overall average for an entire episode of care was $7,233.

Such differences were higher than those of general medical services, as evidenced by a comparison of the initial findings to those from an analysis of the Kaiser Family Foundation Medicaid-to-Medicare fee index. For general medical services, reimbursement ratio disparities were threefold, ranging from as low as 0.38 in Rhode Island to as high as 1.26 in Alaska.

Medicaid reimbursement rates are less in comparison to those offered by Medicare, a trend which can make it more difficult for rural and private practices to prosper, especially when taking into account the added expenses they face in purchasing and maintaining equipment. This can lead to closure, which in turn, limits or removes access for patients to lifesaving medical services.

They also can impact the disproportionate number of radiation oncologists in rural and urban settings, a situation in which a fewer number of physicians are taking up posts in rural communities. Many already in such areas plan to retire in the next few years or reduce their hours, thereby limiting access to care for patients.

"Stable payments (in the Medicare and Medicaid) are essential to allowing cancer centers to operate and provide high quality care to patients," said Agarwal. "While the results of this study are essential data points, sustained advocacy from all healthcare stakeholders is important in order to make policy changes that ensure reasonable payment and access to critical cancer services."

The study was limited by the exclusion of Tennessee, which does not follow a Medicaid fee-for-service model, and Illinois, the fee schedule for which was incomplete.

The findings were published in the International Journal of Radiation Oncology • Biology • Physics (Red Journal).