The Value of Mammography Under Scrutiny…Again

The United States Preventive Services Task Force (USPSTF) announced last Friday that it is going to review its guidelines for breast cancer screening. The process by which the utility of a screening test is determined must be transparent, free of bias and based on the best science available. Back in 2009 the USPSTF decided that women 50-74 only need a mammogram every other year and women under 40 should make an individual decision with their doctor. This, despite ample evidence that mammography saves lives and is efficacious in doing so even for younger women.

At a time when the health care system is trying to function more effectively at lower cost we have to hope that the policy makers and members of the USPSTF will focus on the science and make a decision that reflects that.

It’s 20 years since I was a breast imaging fellow with Dr. Dan Kopans at Massachusetts General Hospital. The misinformation about the value of screening started back then with the Canadian National Breast Screening Study, which was inherently deeply flawed. Alas the drumbeat of scepticism has beat steadily since. Cascading reimbursement cuts to imaging have impacted the availability of mammography services. If the new bundled breast biopsy codes are, as has typically been the case with bundled codes recently, associated with significant decreases in reimbursement, access may decline even further.

Breast cancer awareness month has passed but rest assured that your team at the American College of Radiology works to maintain access to this life saving service for our patients all year round.

Author – Geraldine B. McGinty, M.D., MBA, FACR

ACR’s “Dampening” Legislation

Along with clinical decision support, another concept that is included in the sustainable growth rate (SGR) drafts coming out of Congress  is “dampening.”

Radiology has been hit with 13 cuts in reimbursement since 2006. In most cases, there was no time to strategize and adjust our practice staffing and finances. At its core, dampening legislation would prevent the Centers for Medicare and Medicaid Services from reducing rates for any specific procedure by more than a given amount in a single year.

The original American College of Radiology (ACR) proposal was to limit reductions to 12.5 percent per year. ACR legislation would also require the U.S. Department of Health and Human Services Secretary to disclose any data, analysis and justification if there is more than a 12.5 percent drop or overall reduction of more than $50 million.

This policy would apply across all of medicine, not just radiology. Other specialties have expressed support for the concept.

Currently, the draft proposals for SGR repeal phase in any 20 percent or more RVU cut over two years. While less than what we had hoped, it is recognition that there is significant and unfair impact when onerous reductions are implemented all at once.

ACR is vigorously fighting against any reductions. However, we need to remain part of the conversation as health care changes. Dampening is one way to moderate the impact as we transition from fee-for-service toward alternative payment models.

An independent bill with dampening language is also being prepared in the event the SGR proposal does not survive the legislative debate.

More to come …

Author – Howard B. Fleishon, M.D., MMM, FACR