State-Level Variations in the Utilization of Lung Cancer Screening Among Medicare Fee-for-Service Beneficiaries An Analysis of the 2015 to 2017 Physician and Other Supplier Data
State-Level Variations in the Utilization of Lung Cancer Screening Among Medicare Fee-for-Service Beneficiaries An Analysis of the 2015 to 2017 Physician and Other Supplier Data
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DOI：
10.1016/j.chest.2019.11.005
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发表时间：
2020-04-01
期刊：
影响因子：
9.6
通讯作者：
Taioli, Emanuela
中科院分区：
文献类型：
--
作者：
Liu, Bian;Dharmarajan, Kavita;Taioli, Emanuela
背景：肺癌筛查（LCS）是降低肺癌死亡率的重要二级预防措施。本研究的目的是评估自2015年医疗保险开始其LCS报销政策以来的前三年美国老年人LCS在州一级的变化。方法：本生态研究考察了LCS利用密度（定义为每1000名医疗保险按服务收费（FFS）受益人获得的低剂量CT （LDCT）或共享决策和咨询（SDMC）服务的数量，该数据来自《医疗保险提供者使用和支付数据：医生和其他供应商公共使用文件》）与来自几个公开数据源的州级因素之间的关系。该研究包括Kruskal-Wallis测试和聚类分析。结果：2017年，LDCT和SDMC每1000名医疗保险FFS受益人的中位使用密度分别为3.32和0.46，分别是2015年的24倍和13倍。从2015年到2017年，LCS收费的独特供应商总数从LDCT成像的222家增加到3,444家，从SDMC的20家增加到523家。LDCT和SDMC服务的较高利用率往往集中在东北部和中西部北部各州，而不是西南部各州。高利用密度的州群不包括肺癌死亡率和/或吸烟率最高的州。结论：自医疗保险开始其报销政策以来，LCS的使用稳步增加。在美国，LDCT成像和SDMC之间的使用和增长有所不同，表明LCS和肺癌死亡率和吸烟率高的州有很大的增长潜力。
BACKGROUND: Lung cancer screening (LCS) is an important secondary prevention measure to reduce lung cancer mortality. The goal of this study was to assess state-level variations in LCS among the US elderly during the first 3 years since Medicare began its LCS reimbursement policy in 2015.METHODS: This ecological study examined the relations between LCS utilization density, defined as the number of low-dose CT (LDCT) or shared decision-making and counseling (SDMC) services per 1,000 Medicare fee-for-service (FFS) beneficiaries derived from the Medicare Provider Utilization and Payment Data: Physician and Other Supplier public use file, and state-level factors from several publicly available data sources. The study included Kruskal-Wallis tests and a cluster analysis.RESULTS: In 2017, the median utilization density per 1,000 Medicare FFS beneficiaries was 3.32 for LDCT and 0.46 for SDMC, which was 24 and 13 times the 2015 level, respectively. From 2015 to 2017, the total number of unique providers billed for LCS increased from 222 to 3,444 for LDCT imaging and from 20 to 523 for SDMC. Higher utilizations for both LDCT and SDMC services tended to concentrate in the northeastern and upper Midwest states than in the southwest states. The cluster of states with high utilization density did not include those states with the most lung cancer mortality and/or smoking prevalence.CONCLUSIONS: A steady increase was noted in LCS utilization since Medicare began its reimbursement policy. The utilization and its growth varied across the United States and differed between LDCT imaging and SDMC, indicating large growth potentials for LCS and for states with high lung cancer mortality and smoking prevalence.