Disabled Medicare enrollees are not getting the same care as able-bodied ones
Disabled Medicare beneficiaries are not being screened for cancer as thoroughly as non-disabled enrollees, according to the CMS.
The agency has found that beneficiaries age 65 and older reporting disabilities were less likely to receive mammography screenings, prostate exams and Pap tests than those reporting no disability.
"These data underscore the importance of broad access to screenings to detect cancer in its earliest, most treatable stage," the agency wrote in an analysis released Friday.
Only 59% of disabled Medicare beneficiaries 65 or older received a mammogram in 2013, the period evaluated, compared with 72% of able-bodied enrollees. Only 30% of disabled enrollees received a Pap smear compared with 38% of able-bodied beneficiaries.
In 2013, 22,870 women age 65 and older died from breast cancer, according to the CMS. The findings come at a time that Congress is also seeking ways to better care for disabled seniors.
Disability advocates have noted a general discrepancy in care experiences between non-disabled and disabled patients and said the disparity in treatment may be due in part to provider prejudice.
"There is an assumption that gets compounded by age that disabled patients take so much more work than non-disabled patients to treat," said Silvia Yee, a senior staff attorney at the Disability Rights Education and Defense Fund.
Willi Horner-Johnson who has long studied health disparities for disabled populations notes that despite years of research findings like CMS', providers have made little effort to change.
"The fact that there are no funding or accreditation criteria specifically tied to quality of care for people with disabilities has a lot to do with it," said Johnson, a researcher at Oregon Health and Science University's Institute on Development and Disability.
At least one doctor, Dr. Lynne Lillie, a practicing family physician in Rochester, Minn. and a board member of the American Academy of Family Physicians, said over her 25 years of practicing medicine she hasn't seen the care disparity outlined by the CMS.
If a medical practice finds that it needs to do better to ensure disabled patients are getting necessary services, Lillie supports a medical home model or any effort that calls for coordinating care between a provider and community partners that may be more in tune with unmet beneficiary needs. Lillie was also optimistic that CMS' move to value-based care would lead to better care for disabled patients as practices are increasingly evaluated on if they are improving the quality of care for all patients.
Routine preventive care greater
CMS' report wasn't all bad news for disabled patients. Medicare beneficiaries that were studied were more likely to report routine preventive care, specifically influenza vaccination, pneumococcal vaccination and blood pressure reading.
"That likely happens because a disabled beneficiary is at the provider's office for another reason," said Kathleen Holt, associate director at the Center for Medicare Advocacy. Cancer screenings tend to be separate from primary-care visits and possibly performed elsewhere, such as a radiology site, Holt said.
Providers can improve cancer screening rates by emphasizing to patients that preventive testing is not costlier, despite it likely taking place at a separate appointment. Clinicians can also do more to find out if there are transportation issues or other physical or emotional access barriers that the patient can be counseled through, Holt said.
For providers performing the screenings, more can be done to ensure that equipment and spaces are accessible and that there is more advance planning by the doctor to prepare to examine a special needs patient, said Yee, from the Disability Rights fund.
"From a practical perspective, if providers just know that these patients are coming in and make the necessary accommodations there could be a real shift," she said.
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