Source of Ethnic Disparity in Medicare Claims Unclear

Preventive screening discrepancies found between Medicare claims records and patient reports

FRIDAY, Sept. 29 (HealthDay News) -- Ethnic disparities in preventive screening tests are larger when estimated with Medicare claims than patient self-reports, according to a report published Sept. 29 in BioMed Central Health Services Research.

Kevin Fiscella, M.D., and colleagues from the University of Rochester School of Medicine and Dentistry in Rochester, N.Y., evaluated 49,645 patient records of preventive procedures and compared those with the patients' matched Medicare claims. The authors analyzed six preventive procedures: PSA testing, Pap smear testing, influenza vaccination, cholesterol testing, mammography and colorectal cancer tests.

Except for PSA testing, ethnic disparities in the preventive procedures were larger when based on Medicare claims compared to patient self-reports. After demographic and health status adjustments, the investigators found that minorities were more likely to report preventive procedure receipts without a submitted Medicare claim.

"This study shows that estimates of racial/ethnic disparities, across a variety of preventive care procedures, vary depending on whether self-report or claims are used to assess them. Whether these differences reflect biases in participant report or in billing claims is unclear. These competing explanations have profoundly different policy implications, and thus warrant careful study. Future monitoring of disparities in screening will require more careful distinction of screening from diagnostic uses of preventive procedures," the authors conclude.

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