Patient response to ACA’s cost-free screenings falls flat

The Affordable Care Act mandated that health insurers pick up the full tab for a number of evidence-based, preventive-care procedures. But for two of the top-targeted procedures, mammography and colonoscopy, patients haven’t exactly rushed doctors’ offices to take advantage of the free screening opportunities.

The flat rate of utilization in the wake of the law’s passage may owe to a simple lack of awareness on the part of both patients and doctors, according to the authors behind the study that revealed the non-response.

Led by Shivan Mehta, MD, of the University of Pennsylvania, the researchers looked at the effect of eliminating cost sharing on beneficiaries covered in small-business plans by Humana. The team compared utilization by individuals in plans that were required to eliminate cost sharing with a control group of people in plans temporarily protected from the cost-sharing mandate by a grandfathering provision. They published their results online July 16 in The American Journal of Managed Care.

The sweep of patients eligible for breast-cancer screening included 30,802 women aged 50 to 64 years, while some 63,246 men and women aged 50 to 64 years comprised the cohort eligible for colorectal-cancer screening.

“The results suggest that the implementation of the policy is not having its intended effects,” the authors wrote, “as utilization of colonoscopy and mammography changed little following this new policy approach.”

Along with possible unawareness, the researchers cited as potential turnout-flatteners the fact that they only looked at activity in the nine months after the law took effect in September 2010. They also noted that, by the time the ACA requirement kicked in, many plans had already reduced or cut cost sharing for mammography screenings.

At the same time, the percentage of mammograms with cost sharing did not zero out because some were coded as diagnostic rather than preventive, the authors pointed out. “This reflects aggressive efforts to improve breast cancer screening rates that predated the ACA policy and limited the potential impact of this legislation on mammography screening rates,” they wrote.

“Consideration should be given,” they added, “to waiving cost sharing for all colonoscopies and mammograms in the eligible population.”

The journal has posted the study in its entirety