Last Friday Congress passed legislation to raise reimbursements for digital mammography screening, leaving payments for standard mammography untouched. The piecemeal increase was opposed by many mammographers, as well as the American College of Radiology and other organizations that hoped to craft a more balanced solution to the problem of unsustainably low reimbursement.
"It is a shame that Congress only raised reimbursements for digital mammography since the standard technology is more readily available to most women, and there is considerably more data supporting its use," said Dr. Etta Pisano, chief of breast imaging at the University of North Carolina - Chapel Hill School of Medicine.
The law will drive radiology practices to buy digital mammography systems, and that might not be good, she said, considering that the quality of digital mammography remains unproven. "At this point we know digital is more expensive. We do not know that it is better," Pisano said.
A preliminary study of seven large institutions that provide mammography services recently found that Medicare reimbursement would need to triple in order for the facilities to break even. Providers say they can't afford to continue providing mammography services at a loss.
Part of a larger spending bill passed in the 106th Congress' final hours, H.R. 5661 (Sec. 104) raises Medicare reimbursement for digital mammography to 150% of the rate paid for standard diagnostic radiology.
The increase brings average Medicare reimbursement for full-field digital diagnostic mammography to about $122, leaving the average payment for standard bilateral diagnostic mammography at about $81. (Average reimbursement differs based on what geographic region the facility is located in.)
The new law also provides an extra payment of $15 for the use of technology which converts standard film to a digital image "and subsequently analyzes such resulting image with software to identify possible problem areas," i.e., computer-aided detection (CAD) devices.
The language may be broad, but the field of approved systems for the developing technology remains quite narrow, raising questions about the appropriateness of a separate reimbursement scheme so early in the game.
For example, only the ImageChecker CAD system from R2 Technology of Los Altos, CA, is currently approved by the FDA for breast imaging. And only the Senographe 2000D system from GE Medical Systems of Waukesha, WI is approved for full-field digital mammography.
Last month the American College of Radiology (ACR) complained that the legislation was designed to serve vendors rather than patients, and that it would tie mammography screening to the purchase of technology that had not been scientifically proven to increase the detection of breast cancer.
"Adoption of this provision could be seen to indicate that corporate interests, rather than scientific study, would be allowed to determine medical appropriateness," the ACR wrote in a November news release.
But these days the ACR is looking at the bright side, specifically at the progress it has already made in educating Congress about the problem.
"We've gotten a lot of folks on Capitol Hill's attention, and we're looking forward to the beginning of the next session where we're going to try to get this resolved quickly," commented Josh Cooper, government relations director at the Reston, VA-based ACR. The ACR's message to the next Congress will be straightforward, Cooper said.
"The bottom line is that statutory reimbursement is not matching the costs for many mammographers, and therefore they're going to be questioning whether they can continue their mammography screening practice," he said. "You can't ask these guys to go down the tubes to provide this service."
In addition, Congress has implemented direct reporting requirements and mandatory equipment changes without reconsidering the original reimbursement scheme, he said.
Charles Showalter, the ACR's senior government relations director, said a central question is how digital reimbursement fits into the overall picture.
"Is Congress going to provide additional money to fund the payments for new technology, or is that going to come out of the pool that already exists?" he said. "If it comes out of the existing pool, it's liable to take away money that could be used for funding screen film mammography," he said.
By Eric BarnesAuntMinnie.com staff writer
December 21, 2000
Related Reading
Digital mammography study left hanging in presidential uncertainty, December 13, 2000
Low reimbursement threatens breast imaging services, November 30, 2000
Full-field digital mammography compares well to screen-film, November 27, 2000
Offensive strategy may be mammographers’ best bet in reimbursement war, October 9, 2000
Task, lesion type make a difference in digital mammography display, August 31, 2000
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