Radiology experts say state Medicaid rates must increase to improve imaging access
Radiology experts assert that state Medicaid rates must increase to help improve vulnerable patients’ access to imaging.
Reimbursement for radiology services varies widely among insurers, researchers noted Wednesday in JACR. Commercial reimbursement is roughly 144% of Medicare, for example, while Medicaid is 72% of the latter, according to previous research. However, Medicaid can fluctuate further, with each state setting their own rates for the low-income payment program.
Neiman Health Policy Institute experts sought to standardize the Medicaid versus Medicare difference across state lines to better understand how lower reimbursement impacts access. They found that patients residing in states with higher Medicaid reimbursement rates were more likely to undergo medical imaging.
“While utilization is not a direct measure of access, it is reasonable proxy,” study co-author Elizabeth Rula, PhD, executive director of the ACR-affiliated policy institute, said in a statement. “Our finding was that states with lower reimbursement systematically have less Medicaid imaging utilization than higher-reimbursement states, strongly suggests that reimbursement influences access to care,” she added later.
Rula and colleagues gathered their data from the Transformed Medicaid Statistical Information System, consisting of 100% of claims including the Children’s Health Insurance Program. They excluded dual-eligibles, among others, along with beneficiaries residing in Utah, Hawaii and Nebraska, due to income information. Neiman experts then used a 5% nationally representative sample of Medicare fee-for-service claims data to help calculate average Medicare professional-only claims reimbursement for each imaging modality.
Across nearly 49 million Medicaid beneficiaries, the median rate was about $0.82 spent on computed tomography compared to each $1 spent in Medicare. The median rate was about $0.76 for magnetic resonance imaging, $0.82 for radiography, and $0.85 for both nuclear medicine and ultrasound. For Medicaid beneficiaries, the probability of undergoing CT or MRI was about 26% higher when living in states that reimbursed more for the exams (top 75% vs. bottom 25%). Conversely, the chances were about 21% higher for ultrasound and 32% higher for regular radiography.
Rula and co-authors also charted “substantial” variation in payment rates from one state to the next. For instance, the bottom 25% of lowest-paying states logged a median rate of $0.74 or less for radiography. That’s compared to the top 25%, which had a median of around $0.97 with some paying more than Medicare for an X-ray. Radiography also saw the largest impact on utilization, which was 38% greater in higher-paying states.
“The implication of our study is that increasing state Medicaid reimbursement is a logical option for improving access to care,” Rula said in the announcement. “As a safety net program, Medicaid serves low-income Americans and a disproportionate percentage of beneficiaries who are Black or Hispanic. Eliminating Medicaid reimbursement gaps may reduce the healthcare and outcome disparities experienced by these underserved groups.”
The study also found that higher Medicaid reimbursement was associated with a puzzling nearly 6% lower rate of undergoing a nuclear imaging exam. Researchers did not attempt to ascertain the reason for this. However, they speculated that these scanners are more likely to be owned and operated by hospitals, which are often not-for-profit, deliver charity care, and may be less influenced by these rates. Rula et al. also did not attempt to discern whether the additional imaging delivered in higher-Medicaid-reimbursement geographies was of value or healthcare waste. It is also unclear if states with lower Medicaid rates have less imaging utilization for reasons other than reimbursement.
“Reducing these reimbursement differences by increasing Medicaid reimbursement is important for reducing access and utilization disparities for Medicaid patients, because having Medicaid coverage is not synonymous with equal access to care,” the authors concluded.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.