DISPARITIES IN HEALTHCARE COVERAGE FOR CLEAN INTERMITTENT CATHETERIZATION - A NATIONWIDE ANALYSIS
Joseph P. Bardot, MD, Joe Ortenberg, MD.
LSUHSC School of Medicine/Children's Hospital, New Orleans, LA, USA.
BACKGROUND: At least 300,800 persons in the USA perform clean intermittent catheterization (CIC)*. Children may catheterize the bladder per urethra or through a reconstructed channel and require varying types of catheters and supplies funded by government or private healthcare insurers. For the majority of patients in the USA, the cost of CIC catheter supplies is covered by federal or state healthcare programs. Remuneration to catheter vendors for supplies varies by state and governmental healthcare insurer. Inadequate financial reimbursement may limit the selection and extent of supplies provided. A variety of catheters from different materials are available, including hydrophilic and non-hydrophilic, with no distinction in reimbursement. This study aimed to evaluate national trends in healthcare coverage for CIC supplies, and to evaluate potential areas of disparity between insurance types.
*Sun AJ, Comiter CV, Elliott CS. Neurourology & Urodynamics. 2018;1-5
METHODS: Information was collected from The Centers for Medicare and Medicaid Services to ascertain Medicare (federal) reimbursement to vendors for CIC supplies in 2021. Similar information was obtained for all 50 state Medicaid programs. Differences in reimbursement rates were calculated to illustrate disparities in coverage of wholesale costs for straight catheters, coude catheters, and closed system catheter kits. Reimbursement rates for each state were analyzed to determine whether Medicaid or Medicare reimbursed at higher rates. Standard deviations were calculated to determine how states compared to one another.
RESULTS: At the time of data collection, the difference in Medicaid reimbursement between the highest and lowest funding states was 1305 % for straight catheters, 633 % for coude catheters and 329 % for closed system catheter kits. The percentage of state Medicaid programs within 1 standard deviation of the mean Medicaid reimbursement rate was 98% for straight catheters, 75% for coude catheters, and 75% closed catheter kits. For Medicare programs, the number of states within 1 standard deviation of the Medicare mean was 96% for straight catheters, 96% for coude catheters, and 98% for closed catheter kits. Additionally, the percentage of state Medicaid programs providing lower reimbursement than Medicare (federal) levels was 96% for straight catheters, 96% for coude catheters, and 94% for closed catheter kits.
CONCLUSIONS:In the USA, compared to Medicare, the majority of state Medicaid programs underfund reimbursement for CIC catheter supplies at lower levels than the federal government with the exceptions of North Dakota and New Hampshire. There is a large variation in Medicaid reimbursement between individual states for the same CIC equipment. The differences between state reimbursements for CIC equipment may limit options for Medicaid patients to receive optimal catheter supplies from medical equipment vendors, leading to disparities in their access to CIC catheters. Hydrophilic catheters have a higher production cost, but there is no additional reimbursement despite their long-term health benefits. Our analysis suggests that there is inadequate financial reimbursement to vendors by Medicaid compared to Medicare. We recommend that catheter reimbursement should be more universal nationwide, and a separate reimbursement category be created for hydrophilic catheters.
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