Declining Mammography Screening in a State Medicaid Fee-for-Service Program: 1999–2008

Abstract

Objective: To evaluate and compare annual and biennial mammography screening rates across age, race, and geographic location (rural-urban) and to determine mammography screening persistence over 10 years among women enrolled in the West Virginia (WV) Medicaid Fee-for-Service (FFS) program. Methods: The WV Medicaid FFS administrative claims data for women recipients aged 40-64 from 1999 to 2008 were used for study purposes. Annual and biennial screening rates and persistence with screening were determined for women who were continuously enrolled in the WV Medicaid FFS program for respective calendar years. Results: A steady decline in the annual and biennial screening rates over a 10-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) was observed among women recipients aged 40-64 years in the WV Medicaid FFS program, and screening persistence was also lower. Both annual and biennial screening rates and persistence varied by different demographic characteristics. Conclusions: Although mammography screening services are covered under Medicaid programs, underuse persists as a major concern. The results of this study emphasize the need to identify and address barriers to mammography screening in low-income rural populations.

Evaluating and comparing methods for measuring spatial access to mammography centers in Appalachia

“…The region has been designated as a special population of interest by the National Cancer Institute because of disparities in cancer outcomes and treatment patterns (Lane et al, 2012; Lengerich et al, 2005). An example of these disparities are higher mortality rates for lung and bronchus, colon, and cervical cancer (Blackley, Behringer, & Zheng, 2012); reduced mammography screening (Bhanegaonkar et al, 2012); and lower rates of breast conserving surgery, rather than mastectomy (Freeman, Huang, & Dragun, 2012). Human population in Appalachia is sparse, with 42 percent of the population classified as rural, as compared to a national average of 20 percent (ARC, 2014).…”

PHS57 Comparing Predictors of Self-Reported Adherence to Mammography Screening Guidelines in Appalachian Women Who Utilize Mobile and Stationary Facilities

“…24 This finding is also in contrast to a previous study on WV women 12 and a recent study on WV Medicaid fee-for-service women. 13 The high mammography screening rate among women who utilized stationary facility suggests that these women never have had or have already overcome the majority of the barriers to mammography screening. In addition, the screening facility is located in a university town which may introduce some bias in the selection of the sample which may have ultimately resulted in higher screening rates.…”

“…12 Another recent study indicated that less than 40% of WV Medicaid fee-for-service women had a mammogram related billing in 2007–2008 within the previous two years although mammography screening is covered by WV Medicaid. 13 The authors of this study suggested that there may be factors other than insurance coverage and financial constraints, such as lack of knowledge about mammography, views and attitudes about mammography screening, lack of physician recommendation, lack of transportation, which may influence screening rates in the WV Medicaid population. 13 Thus, there is a vital need to determine the predictors of adherence to mammography screening guidelines in WV women who routinely utilize stationary mammography facilities to get mammograms.…”

“…13 The authors of this study suggested that there may be factors other than insurance coverage and financial constraints, such as lack of knowledge about mammography, views and attitudes about mammography screening, lack of physician recommendation, lack of transportation, which may influence screening rates in the WV Medicaid population. 13 Thus, there is a vital need to determine the predictors of adherence to mammography screening guidelines in WV women who routinely utilize stationary mammography facilities to get mammograms. Hence, the objectives of this research study are to describe the characteristics of women age 40 years and above who utilize a stationary mammography facility and to determine the predictors of self-reported adherence to mammography screening guidelines by comparing women who are adherent with those who are not.…”

Do Appalachian Women Attending a Mobile Mammography Program Differ from Those Visiting a Stationary Mammography Facility?

“…A study on screening using the Behavioral Risk Factor Surveillance System self-reported data indicated that 74.5 % of WV women had a mammogram in the past 2 years compared to 76.6 % women nationally [20]. However, a recent study about mammography screening in WV Medicaid fee-for-service women indicated that less than 40 % of women had a mammogram related billing in 2007–2008 within the previous 2 years although mammography screening service is covered by WV Medicaid [22]. Thus, these studies highlight the need for increasing mammography screening rates among women in WV.…”