Humans, by nature, are complex; they’re sometimes puzzles to be studied and solved. On paper, they can be divided and classified, neatly sifted into categories based on codes and diagnoses and demographics; this makes them more decipherable, but no less fascinating. For Lorens Helmchen, PhD, a scholar who speaks enthusiastically of his research, that deep dive into data and the resulting percentages and probabilities provide insight into three parties in health care: patient, provider, and insurer.
Helmchen’s study, “The Impact of Greater Reimbursement for Chemotherapy Drugs on Cancer Care Among DC Medicaid Enrollees," focuses primarily on the effect of a 2016 Medicaid policy that increased the reimbursement of physician-administered chemotherapy drugs to 100% from 80% of the Medicare fee schedule. The initial funding for the study came from the Cyrus and Myrtle Katzen Cancer Research Center’s Catchment Area Pilot Awards, which are intended to promote research that improve cancer health outcomes for individuals in the Washington, D.C., area.
“What we wanted to do was understand how did care change in the aftermath of this policy change," explains Helmchen, associate professor of health policy and management at the Milken Institute School of Public Health at the George Washington University (GW) and a member of the GW Cancer Center.
The preliminary takeaways of this study on the reimbursement change are intriguing: providers may increase the frequency of diagnostic testing and aggressive treatment, patients may see more health care providers, and financial incentives from insurers can be powerful motivators.
Helmchen cautions that he cannot attribute these changes unambiguously to the policy change because the study was descriptive; he looked solely at medical claims of patients who were covered by Medicaid and thus were all exposed to the policy change. The claims contained patient demographic information - age, gender, race, and place of residence - as well as diagnostic and procedural codes. He studied approximately 2,100 Medicaid enrollees whose medical claims recorded a diagnosis of prostate cancer and approximately 2,600 Medicaid enrollees whose medical claims included a breast cancer diagnosis between 2013 and 2017. “We [then] used the claims to characterize what happened after the policy had gone into effect," he says. “So, what did we find?"
One of the “most salient findings," he says, was on the treatment arc for prostate cancer patients diagnosed within the aforementioned five-year range. “We detected an increase in the probability that they would receive a CT scan or an MRI scan or a bone scan of about 7.5 percentage points, so that’s fairly significant."
He also focused on whether these patients received any of three types of treatments: chemotherapy, radiation, or surgery. “After the policy had been implemented in 2016, prostate cancer patients in the Medicaid program were about a third more likely to receive treatment than before," he says.
There was, however, one unexpected finding. Helmchen expected patients to receive chemotherapy more often than before the policy change because its reimbursement had increased. Early results indicate otherwise; there was no statistically significant increase in the use of chemotherapy, or radiation and surgery. (Breast cancer patients, as a whole, did not see a statistically significant change in treatment patterns at all.)
He notes that the lack of such a change in treatment patterns “gives a lot of credit to the providers. Financial inducements failed to bring about a detectable change in the treatment patterns [for breast and prostate cancer patients], other than raising the probability of CT and MRI scans for prostate cancer patients and raising the overall treatment for prostate cancer patients."
So, what does that mean? The policy change could have appealed to providers to continue treating prostate and breast cancers with the same number of chemotherapy agents, rather than expanding the treatment plan to include potentially more chemotherapy or the additional invasive options of surgery plus radiation.
“If [treating patients with chemotherapy agents] is financially attractive for providers, then providers have an incentive to encourage greater rates of diagnosis, so that would be consistent with our finding that the probability of receiving a CT or MRI scan increased," Helmchen explains. “And … you’re bound to find more cancers if you increase the diagnostic effort."
“If you make it more attractive to provide chemotherapy treatment, you make it more attractive for additional providers to see patients, so perhaps it’s not too surprising that patients would see more providers because they have more choice now," Helmchen concludes.
