Factors Influencing Receipt of Interventional Pain Management Among Medicaid Beneficiaries with Cancer

Background: Pain is common among cancer patients. Nonclinical factors may affect receipt ofpain management among Medicaid beneficiaries with cancer.Objectives: To examine associations of patient characteristics and US state-level Medicaidpolicies on receipt of interventional pain management among Medicaid beneficiaries with breastor 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 yearswith breast or colorectal cancer was identified using procedure codes in Medicaid claims data.State-level Medicaid policy variables included physician visit reimbursements, required patientcopayments, and time period for Medicaid eligibility recertification (12 vs. < 12 months). Analysesalso examined beneficiary race/ethnicity, age, comorbidities, and cancer treatment. Generalizedestimating equations controlling for clustering by state assessed factors influencing receipt ofinterventional 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 interventionalpain management. Medicaid policies were not significantly associated with receipt of interventionalpain services. Among breast cancer patients, older age and non-Hispanic white race/ethnicitywere associated with decreased likelihood of receiving interventional pain management; morecomorbidities and receipt of breast conserving surgery were associated with increased likelihood.Demographic characteristics were not significantly associated with receipt of interventional painmanagement among colorectal cancer patients.Limitations: Sample size of Medicare beneficiaries with cancer receiving interventional painmanagement; limited information included in Medicare claims data.Conclusions: State-level Medicaid policies were not significantly associated with receipt ofinterventional pain management for breast or colorectal cancer patients; disparities in receiptof these services were observed only for breast cancer patients. These results may help developpolicies 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, claimsanalyses