1. 2019;22;E147-E155Factors Influencing Receipt of Interventional Pain Management Among Medicaid Beneficiaries with Cancer
   Open Label Study
   Michael T. Halpern, MD, PhD, and Mallorie H. Fiero, PhD.

BACKGROUND: Pain is common among cancer patients. Nonclinical factors may affect receipt of pain management among Medicaid beneficiaries with cancer.

OBJECTIVES: To examine associations of patient characteristics and US state-level Medicaid policies on receipt of interventional pain management among Medicaid beneficiaries with breast or colorectal cancer.

STUDY DESIGN: A retrospective analysis of 2006-2008 Medicaid claims data.

SETTING: Claims data from facilities providing care to Medicaid beneficiaries.

METHODS: Interventional pain management among Medicaid beneficiaries aged 18-64 years with breast or colorectal cancer was identified using procedure codes in Medicaid claims data. State-level Medicaid policy variables included physician visit reimbursements, required patient copayments, and time period for Medicaid eligibility recertification (12 vs. < 12 months). Analyses also examined beneficiary race/ethnicity, age, comorbidities, and cancer treatment. Generalized estimating equations controlling for clustering by state assessed factors influencing receipt of interventional pain management.

RESULTS: The study included 8,438 Medicaid beneficiaries with breast or colorectal cancer. Colorectal cancer (vs. breast cancer) patients were significantly more likely to receive interventional pain management. Medicaid policies were not significantly associated with receipt of interventional pain services. Among breast cancer patients, older age and non-Hispanic white race/ethnicity were associated with decreased likelihood of receiving interventional pain management; more comorbidities and receipt of breast conserving surgery were associated with increased likelihood. Demographic characteristics were not significantly associated with receipt of interventional pain management among colorectal cancer patients.

LIMITATIONS: Sample size of Medicare beneficiaries with cancer receiving interventional pain management; limited information included in Medicare claims data.

CONCLUSIONS: State-level Medicaid policies were not significantly associated with receipt of interventional pain management for breast or colorectal cancer patients; disparities in receipt of these services were observed only for breast cancer patients. These results may help develop policies to enhance access to appropriate pain management services.

KEY WORDS: Cancer pain, pain management, Medicaid, health care disparities, breast neoplasms, colorectal neoplasms, health policies, physician practice patterns, retrospective studies, claims analyses