CMS Proposes Diagnostic Mammogram Rate Cut to Hospitals
The Centers for Medicare and Medicaid Services (formerly HCFA) is proposing a 7.5% reduction in reimbursements to hospitals for diagnostic mammograms next year "despite complaints that current rates" for the "widely used breast-cancer test" are "so low that centers" have been "forced" to stop offering them, the Wall Street Journal reports. CMS has placed the proposed change for the mammograms, as well as new payments for "thousands" of outpatient procedures, on its Web site, and has "set a 40-day comment period" for the proposals, which are set to take effect on Jan. 1. Under the new mammogram rate, hospitals would receive $32.54 for the procedure, down from the current $35.17. According to the American College of Radiology, "routine mammograms" -- which are "less complex" than the "intensive" diagnostic mammograms and would not be affected by the proposed changes -- cost hospitals $97.48. "Hospitals will be forced to re-evaluate whether they can afford to continue absorbing the losses incurred by providing this critical health service," William Thorwath of the college said. Last year, Medicare covered six million mammograms, the Journal reports, though it does not indicate how many of these were diagnostic and how many were routine. But low payment rates have led many centers that offer the procedures to "close or scale back," leading to months-long waiting lists. According to Linda Frame, senior clinical adviser at the Dallas-based Susan G. Komen Breast Cancer Foundation, the number of "certified mammography facilities" had declined from 9,873 in March to 9,600 this month. A CMS spokesperson said that diagnostic-mammogram payment rates were "only a proposal," adding that the "new rates for several thousand procedures" taken together would result in an overall 2.3% increase in reimbursement rates to hospitals.
CMS also is proposing a rate increase for surgical breast biopsies and a rate reduction for non-surgical biopsies, a move that would "widen the gap" that advocates contend "provides incentives for doctors to do a surgical procedure to obtain tissue to test for cancer when many patients would prefer less-invasive alternatives," the Journal reports. Under the proposal, the rate for the surgical procedure, which "typically involves" an "incision in the patient's breast" to test for cancer, would increase 22% to $760.09. Meanwhile, the rate for the "so-called core needle biopsies," in which doctors "perform the same task just as effectively using a thin needle to remove breast tissue," would decrease 6% to $384.87. A study found that 78% of Medicare beneficiaries who underwent biopsies in 1998 had the surgical procedure (Martinez, Wall Street Journal, 8/23). Further information on the proposed outpatient rates is available from CMS at http://www.hcfa.gov/regs/propcy2002.htm.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.