Medicare beneficiaries are not seeking more preventive screenings, even though the Affordable Care Act makes them available at no cost—and the CMS is trying to figure out why.
“We thought (eliminating cost-sharing) would increase uptake because beneficiaries wouldn't be put off by the costs,” Lara Strawbridge, a social science research analyst at the Center for Medicare and Medicaid Innovation, said Wednesday during a meeting of HHS' Advisory Panel on Outreach and Education (APOE). “But when we compare with claims from before the Affordable Care Act, we see few changes. In fact, we've seen some services have had notable decreases in use.”
The agency did not provide detailed data during the meeting, or identify which screenings people were seeking less often. It's possible that screening declines are tied to changes in recommendations by the U.S. Preventive Services Task Force, Strawbridge said.
The CMS did reveal disparities in screening utilization. In 2014, the most recent year for which data are available, men were 14% less likely to get colorectal screenings than women, and blacks were 40% less likely to get a pneumococcal vaccine than whites. And people dually eligible for Medicare and Medicaid (those who are poor, disabled or both) were 19% less likely to get a flu vaccine than other beneficiaries.
The CMS is planning a series of focus groups to understand why beneficiaries are not taking advantage of the screenings, and will compile their findings in a research paper, said Caitlin Cross-Barnet, another social science research analyst at the CMS Innovation Center.
The agency turned to APOE, a committee composed of patient advocates, payers, researchers and providers that advises HHS on outreach and implementation around the agency's various programs, to explore the trends and identify ways to get more beneficiaries to seek preventive screenings.
One hurdle is that providers are reluctant to become responsible for identifying next steps for patients based on their screening results. For instance, a primary-care physician may not know what to do if a behavioral-health screening suggests a patient is abusing alcohol, said Dr. Roanne Osborne-Gaskin, an APOE member and senior medical director at MDwise, a Medicaid managed-care company.
And physicians may also fear the screenings expose them to additional legal liability.
“If I have in (a patient's) record that they were depressed or having thoughts about self-harm, and I didn't actively do something, there is risk associated with that," said Deena Chisolm, a panel member and associate professor of pediatrics and public health at Ohio State University.
Chisholm also said she has observed that, at least in pediatric practice, physicians avoid certain behavioral-health screenings because they don't have time to deal with the emotional fallout of certain results.
“Rather than having to blow up their day on one patient, they don't do (the screening),” Chisolm said.
Another factor could be that Medicare beneficiaries may have not previously sought screenings, and either aren't interested or don't know about the coverage.
Panel members said it's unclear how much the CMS has done to publically promote that the screenings are now free, which they said the government should be doing across media platforms and in multiple languages.
“Having done nothing isn't enough,” said Dr. Robert Dale Blasier, a professor of orthopedic surgery at Arkansas Children's Hospital in Little Rock. Medicare beneficiaries, he said, “just don't know about it.”