CHICAGO - Mammography services are such a losing proposition for hospitals that unless reimbursement rates increase dramatically, facilities may have to shut down, researchers announced yesterday at the RSNA meeting.
In fact, one mammography center in New York has closed its doors -- even though the institution keeps paying rent on the shuttered office. "It was determined that it would be less expensive to pay rent and not treat patients, than to perform mammographies," said Dr. Gillian Newstead, MD, director of breast imaging at New York University Medical Center.
Newstead, a member of a panel discussing a pending crisis in mammography services in the United States, and others said other facilities are also closing, although little fanfare accompanies their demise.
A major reason: Lack of adequate reimbursement and its cascading impact on getting people interested in the field.
The study outlined by Dr. Dieter Enzmann, chairman of the department of radiology at Northwestern University Hospital, Chicago, indicates that adequate reimbursement would be a substantial change. "We would have to multiply reimbursement by a factor of three in order to break even on the cost of doing diagnostic mammography," said Enzmann.
Enzmann said his study will be published in the spring, and will represent the first cost analysis of mammography services. He suggested that the information be used to lobby for more payments from government and third-party insurers. "We now have the data," he said.
Enzmann surveyed costs, expenses and reimbursements at seven academic institutions from Texas to Chicago to New York that performed between 10,000 and 50,000 mammography exams per year. "Every one of these institutions lost money on mammography services," he said. "The losses were in the hundreds of thousands of dollars a year."
In the panel press briefing at the 86th scientific assembly of the Radiological Society of North America, Enzmann said, "We are not in a crisis at the moment," said Enzmann, "but all this does not portend well for the future."
More troubling than the loss of money on mammography services, said Dr. Ellen Mendelson, MD, director of the breast diagnostic imaging center at Western Pennsylvania Hospital, Pittsburgh, was that the economics of the service meant that "the more you do, the more you lose." Normally, hospitals that develop expertise in particular areas can do better economically than centers that do fewer such cases.
Enzmann said that model doesn't work for mammography. Currently, Medicare reimburses screening mammograms at an average rate of $68 – there are regional differences - and diagnostic mammograms at $81 each, said Dr. Stephen Feig, MD, director of breast imaging, Mt. Sinai Medical Center, New York. He said that reimbursement rates set by insurers are based on that rate. However, panel members said patients who pay cash for the studies will be charged $175 to $275.
But if economics were the only problem, said Dr. David Dershaw, MD, director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York, the crisis might be manageable. But other problems loom:
--The number of applicants for fellowships in mammography has fallen precipitously. Newstead said applications are down 75 percent at NYU; Dershaw said applications have fallen from 40 to 12 in one year at Sloan-Kettering.
--The shortage of qualified mammographers is nationwide. "I get three to five requests for a breast imaging resident a week,” said Dershaw. He said he receive three requests in one day at the RSNA meeting.
--The prospect of facing medical malpractice lawsuits for failing to detect cancer on a mammograms -- and 10 to 15 percent of cases where a cancer cannot be seen -- also reduces interest in performing the services.
--New modalities such as digital mammography are going unused. "These machines cost about $200,000 compared to $75,000 for a regular film machine," said Feig, and coupled with losses in performing such studies, "we are less likely to see digital mammography."
---Women will have to wait longer for screening and diagnostic mammograms. "There is a growing waiting time, perhaps as much as a 50% increase in wait time for these services," said Dr. Dershaw. He said such waits could be as long as two months, and he was concerned that when faced with such a wait, these women "may perceive that it is not worth the effort to be screened."
Enzmann said that in his survey of the academic institutions he found that screening mammograms made a small profit, but that was completely wiped out by the costs involved in the diagnostic examination. Dershaw said that even screening mammograms lost money at his institution.
"I don't think it takes much imagination to realize that certainly within five years if something doesn't happen to correct this situation we are not going to be able to provide this service," Dershaw said.
Mendelson said the success of public education efforts to get women to undergo mammograms is also causing the incipient crisis. She said women have heeded the calls to get a mammogram, recognizing that the screening program has cut risk of dying from breast cancer by 30 to 40 percent because the mammogram can find the cancer at its earliest stage, improving the chance of curative surgery.
Now, she said, the panel is seeking public support in its attempt to get reimbursement that will make mammography financial feasible for the future.
By Edward Susman
AuntMinnie.com contributing writer
November 30, 2000
In fact, one mammography center in New York has closed its doors -- even though the institution keeps paying rent on the shuttered office. "It was determined that it would be less expensive to pay rent and not treat patients, than to perform mammographies," said Dr. Gillian Newstead, MD, director of breast imaging at New York University Medical Center.
Newstead, a member of a panel discussing a pending crisis in mammography services in the United States, and others said other facilities are also closing, although little fanfare accompanies their demise.
A major reason: Lack of adequate reimbursement and its cascading impact on getting people interested in the field.
The study outlined by Dr. Dieter Enzmann, chairman of the department of radiology at Northwestern University Hospital, Chicago, indicates that adequate reimbursement would be a substantial change. "We would have to multiply reimbursement by a factor of three in order to break even on the cost of doing diagnostic mammography," said Enzmann.
Enzmann said his study will be published in the spring, and will represent the first cost analysis of mammography services. He suggested that the information be used to lobby for more payments from government and third-party insurers. "We now have the data," he said.
Enzmann surveyed costs, expenses and reimbursements at seven academic institutions from Texas to Chicago to New York that performed between 10,000 and 50,000 mammography exams per year. "Every one of these institutions lost money on mammography services," he said. "The losses were in the hundreds of thousands of dollars a year."
In the panel press briefing at the 86th scientific assembly of the Radiological Society of North America, Enzmann said, "We are not in a crisis at the moment," said Enzmann, "but all this does not portend well for the future."
More troubling than the loss of money on mammography services, said Dr. Ellen Mendelson, MD, director of the breast diagnostic imaging center at Western Pennsylvania Hospital, Pittsburgh, was that the economics of the service meant that "the more you do, the more you lose." Normally, hospitals that develop expertise in particular areas can do better economically than centers that do fewer such cases.
Enzmann said that model doesn't work for mammography. Currently, Medicare reimburses screening mammograms at an average rate of $68 – there are regional differences - and diagnostic mammograms at $81 each, said Dr. Stephen Feig, MD, director of breast imaging, Mt. Sinai Medical Center, New York. He said that reimbursement rates set by insurers are based on that rate. However, panel members said patients who pay cash for the studies will be charged $175 to $275.
But if economics were the only problem, said Dr. David Dershaw, MD, director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York, the crisis might be manageable. But other problems loom:
--The number of applicants for fellowships in mammography has fallen precipitously. Newstead said applications are down 75 percent at NYU; Dershaw said applications have fallen from 40 to 12 in one year at Sloan-Kettering.
--The shortage of qualified mammographers is nationwide. "I get three to five requests for a breast imaging resident a week,” said Dershaw. He said he receive three requests in one day at the RSNA meeting.
--The prospect of facing medical malpractice lawsuits for failing to detect cancer on a mammograms -- and 10 to 15 percent of cases where a cancer cannot be seen -- also reduces interest in performing the services.
--New modalities such as digital mammography are going unused. "These machines cost about $200,000 compared to $75,000 for a regular film machine," said Feig, and coupled with losses in performing such studies, "we are less likely to see digital mammography."
---Women will have to wait longer for screening and diagnostic mammograms. "There is a growing waiting time, perhaps as much as a 50% increase in wait time for these services," said Dr. Dershaw. He said such waits could be as long as two months, and he was concerned that when faced with such a wait, these women "may perceive that it is not worth the effort to be screened."
Enzmann said that in his survey of the academic institutions he found that screening mammograms made a small profit, but that was completely wiped out by the costs involved in the diagnostic examination. Dershaw said that even screening mammograms lost money at his institution.
"I don't think it takes much imagination to realize that certainly within five years if something doesn't happen to correct this situation we are not going to be able to provide this service," Dershaw said.
Mendelson said the success of public education efforts to get women to undergo mammograms is also causing the incipient crisis. She said women have heeded the calls to get a mammogram, recognizing that the screening program has cut risk of dying from breast cancer by 30 to 40 percent because the mammogram can find the cancer at its earliest stage, improving the chance of curative surgery.
Now, she said, the panel is seeking public support in its attempt to get reimbursement that will make mammography financial feasible for the future.
By Edward Susman
AuntMinnie.com contributing writer
November 30, 2000
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