Ankit Agarwal, MD, MBA

Ankit Agarwal

Medicaid coverage and payment rates for radiation oncology services vary substantially across the U.S., according to study results published in International Journal of Radiation Oncology Biology Physics.

The state-by-state variations, which correlate modestly with broader medical fees based on the Kaiser Family Foundation index, could add to regional disparities in access to care, researchers wrote.

“There are well-known disparities between folks with private insurance and Medicaid insurance in terms of cancer treatment and outcomes,” Ankit Agarwal, MD, MBA, radiation oncology resident physician at The University of North Carolina at Chapel Hill, said in an interview with HemOnc Today. “It’s also fairly well-known that there are variations between states for things like pediatric care. I wanted to do a deep dive in oncology services, and specifically radiation oncology, to see if these disparities were greater or lesser in radiation oncology.”

Agarwal and colleagues sought to analyze variations in Medicaid fees for radiation oncology using the common scenario of a patient who received hypofractionated whole left breast radiation (16 fractions) with deep inspiratory breath-hold technique and an electron tumor bed boost (five fractions) as the reference.

They identified Current Procedural Terminology codes billed for a course of whole breast radiation. They and reviewed publicly accessible Medicaid fee schedules for the last quarter of 2017 to determine reimbursement for each service and for the entire episode of care. The researchers quantified the extent of variation in reimbursement among states by calculating the range, mean, standard deviation and coefficient of variation. They also compared the cost of care for the entire treatment episode with the Kaiser Family Foundation Medicaid-to-Medicare fee index to determine if the trend in reimbursement variation in general medical services is a predictor of the variation observed in radiation oncology.
The analysis included data available for 48 states and Washington, D.C. Tennessee does not adhere to a Medicaid fee-for-service model, and the fee schedule for Illinois was incomplete.

Results showed mean total episode reimbursement — not including imaging guidance for respiratory tracking, which was paid for in only 21 states — of $7,233 (standard deviation, $2,248; coefficient of variation, 31.8%). Total reimbursement ranged from $2,945 in New Hampshire to $15,218 in Delaware, a fivefold difference. This outpaced differences with other Medicaid reimbursements.

Based on the Kaiser Family Foundation index, reimbursement ratios for general medical services ranged from 0.38 in Rhode Island to 1.26 in Alaska, a threefold difference. The correlation coefficient between a state’s Kaiser Family Foundation index and the calculated radiation oncology fees for the full episode of care was 0.55.

“I was surprised to find that the disparities are actually greater in radiation oncology than even in other medical fields, generally, for Medicaid reimbursements,” Agarwal told HemOnc Today. “I imagine that they have advanced effects in terms of access to care for a lot of patients.”

The researchers acknowledged limitations to their study, noting that the variations in payment rates from Medicaid do not consider differences in practice costs between locations.

“We know there’s a shortage of radiation oncologists in rural areas, and in cancer specialists in general,” Agarwal said. “One of the reasons is that there just may not be enough payment to justify having a cancer center or radiation oncologist in those areas. So, this is one of the tools that state legislators and policymakers may have to implement to provide better cancer services in order to attract folks to their area.” – by Jennifer Byrne

For more information:

Ankit Agarwal, MD, MBA, can be reached at Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7512; email: aagarwal@bu.edu.

Disclosures: Agarwal and the other authors report no relevant financial disclosures.

Ankit Agarwal, MD, MBA

Ankit Agarwal

Medicaid coverage and payment rates for radiation oncology services vary substantially across the U.S., according to study results published in International Journal of Radiation Oncology Biology Physics.

The state-by-state variations, which correlate modestly with broader medical fees based on the Kaiser Family Foundation index, could add to regional disparities in access to care, researchers wrote.

“There are well-known disparities between folks with private insurance and Medicaid insurance in terms of cancer treatment and outcomes,” Ankit Agarwal, MD, MBA, radiation oncology resident physician at The University of North Carolina at Chapel Hill, said in an interview with HemOnc Today. “It’s also fairly well-known that there are variations between states for things like pediatric care. I wanted to do a deep dive in oncology services, and specifically radiation oncology, to see if these disparities were greater or lesser in radiation oncology.”

Agarwal and colleagues sought to analyze variations in Medicaid fees for radiation oncology using the common scenario of a patient who received hypofractionated whole left breast radiation (16 fractions) with deep inspiratory breath-hold technique and an electron tumor bed boost (five fractions) as the reference.

They identified Current Procedural Terminology codes billed for a course of whole breast radiation. They and reviewed publicly accessible Medicaid fee schedules for the last quarter of 2017 to determine reimbursement for each service and for the entire episode of care. The researchers quantified the extent of variation in reimbursement among states by calculating the range, mean, standard deviation and coefficient of variation. They also compared the cost of care for the entire treatment episode with the Kaiser Family Foundation Medicaid-to-Medicare fee index to determine if the trend in reimbursement variation in general medical services is a predictor of the variation observed in radiation oncology.
The analysis included data available for 48 states and Washington, D.C. Tennessee does not adhere to a Medicaid fee-for-service model, and the fee schedule for Illinois was incomplete.

Results showed mean total episode reimbursement — not including imaging guidance for respiratory tracking, which was paid for in only 21 states — of $7,233 (standard deviation, $2,248; coefficient of variation, 31.8%). Total reimbursement ranged from $2,945 in New Hampshire to $15,218 in Delaware, a fivefold difference. This outpaced differences with other Medicaid reimbursements.

Based on the Kaiser Family Foundation index, reimbursement ratios for general medical services ranged from 0.38 in Rhode Island to 1.26 in Alaska, a threefold difference. The correlation coefficient between a state’s Kaiser Family Foundation index and the calculated radiation oncology fees for the full episode of care was 0.55.

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“I was surprised to find that the disparities are actually greater in radiation oncology than even in other medical fields, generally, for Medicaid reimbursements,” Agarwal told HemOnc Today. “I imagine that they have advanced effects in terms of access to care for a lot of patients.”

The researchers acknowledged limitations to their study, noting that the variations in payment rates from Medicaid do not consider differences in practice costs between locations.

“We know there’s a shortage of radiation oncologists in rural areas, and in cancer specialists in general,” Agarwal said. “One of the reasons is that there just may not be enough payment to justify having a cancer center or radiation oncologist in those areas. So, this is one of the tools that state legislators and policymakers may have to implement to provide better cancer services in order to attract folks to their area.” – by Jennifer Byrne

For more information:

Ankit Agarwal, MD, MBA, can be reached at Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7512; email: aagarwal@bu.edu.

Disclosures: Agarwal and the other authors report no relevant financial disclosures.

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Medicaid reimbursement for radiation oncology services varies substantially among states – Healio