MAMMOGRAMS: Low Payments Put Squeeze on Availability
Due to insurers' low reimbursement rates for mammograms and a declining number of radiologists entering the field, "American women's ready access to breast cancer screening is being compromised," the Wall Street Journal reports in a front page look at the current "screening crunch." Although "record numbers" of women over 39 are receiving an annual mammogram, some radiologists and imaging centers are closing operations as a money-losing business, and those that remain open are "so overwhelmed that even high-risk patients may face potentially dangerous waits for appointments." Radiologists claim that reimbursement rates for the test have declined over the past several years, sometimes to a point at which the fees they receive are less than the costs of providing the test. Many insurers base their payments on Medicare's rates, which allot centers and clinics $46.11 for a mammogram plus $21.70 in radiologist fees; for the more intensive diagnostic mammogram, however, Medicare averages payments of only $33.94. The Journal notes that the disparity has put many facilities "into a tighter bind." The American College of Radiology has appealed the rates and HCFA is reviewing possible changes, but they would not go into effect until 2002. Furthermore, many centers report that private insurers pay up to 40% to 60% less than the Medicare rates.
As a result of the inadequate reimbursements, some centers are canceling managed care contracts and asking patients to pay as much as $200 out-of-pocket to cover mammography costs. Still, the payment squeeze has dissuaded many young radiologists from entering the field at all -- about 1,800 student specialists took the national mammography exam in 1999, less than half the number who took the exam in 1997, the Journal reports. In addition, the number of malpractice suits involving failure to detect breast cancer is second only to those involving newborns' injuries during delivery; among radiology procedures, these cases are the most expensive to settle. The American Cancer Society estimates that one million additional women should be encouraged to get an annual mammogram, making the current crunch a "troubling trend" (Martinez, Wall Street Journal 10/30).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.