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In addition to providing healthcare coverage for elderly individuals, CMS offers coverage for younger patients with chronic disabilities. Like all Medicare enrollees, these patients have the option to subscribe to a Medicare Advantage plan.
University of Minnesota health policy analysts reviewed the number of contacts these Medicare enrollees had with providers to determine whether there was a correlation between more frequent visits and earlier breast cancer diagnosis. They also compared the timing of breast cancer diagnosis for women with chronic disabilities enrolled in a Medicare Advantage plan versus those participating in Medicare’s conventional fee-for-service (FFS) program.
Using SEER cancer registry data linked to Medicare enrollment records, researchers identified 3852 disabled women aged 21 to 64 years who received a diagnosis of in situ or invasive breast cancer in July 1992-December 2002. Of these, 3428 were enrolled in traditional FFS Medicare and 424 were enrolled in a Medicare Advantage managed care plan. Researchers stratified patients enrolled in FFS Medicare into “no use,” “low use,” or “high use” groups according to the number of hospital and physician visits accrued in the 6 to 18 months prior to breast cancer diagnosis.
Overall, 10.4% of women in the FFS population and 6.4% in the Medicare Advantage program were likely to be diagnosed as having stage III/ IV breast cancer (P = .02). The study found that women enrolled in FFS Medicare were more likely than women enrolled in a Medicare Advantage plan to receive a diagnosis of late-stage breast cancer (stage III/IV) if they had fewer than 12 physician visits within 18 months of diagnosis. A total of 14.0% of women in the FFS Medicare no-use cohort received a diagnosis of late-stage breast cancer compared with 12.2% of women in the low-use cohort. The highest users of health services had no increased risk of late-stage diagnosis regardless of Medicare enrollment status.
The authors noted that they found no differences in treatment patterns among the cohorts studied. They concluded, “Given that a difference was found in stage at diagnosis but not in treatment, the disparities within this publicly insured population seem to occur before diagnosis. It is plausible that disparities could be reduced or eliminated by promoting the use of primary and preventive care services among women who are less intensive users of healthcare within FFS Medicare.”
Habermann EB, Virnig BA, Durham SB, et al. Managed care enrollment and chronically disabled women with breast cancer.
Am J Manag Care. 2008;14:514-520.