Time Examines Mammogram Screening Delays
Low Medicare and managed care reimbursement combined with a high rate of malpractice claims for radiologists have led to a shortage of mammography services, causing some women to wait up to five months for appointments, Time magazine reports. While women who have "suspicious" lumps or other symptoms can usually be seem in a few days, those who hope for early detection of the smallest tumors, which carries the highest chances of survival, must wait. At present, the Medicare reimbursement rate -- often used as a "starting point" for private insurers in setting payment rates -- is about $69 per mammogram, while the cost incurred by imaging centers can run from "$100 to $150." The discrepancy is "squeez[ing]" imaging centers, causing many to curtail services or close altogether. Further, radiologists are at high risk for malpractice suits over "failure to diagnose breast cancer." Mammograms, "by their very nature," miss between 10% and 15% of all breast cancers, meaning that "even the best radiologists won't spot one cancer for every nine they detect." Time notes that the number of applicants for the five breast radiology training positions at New York's Memorial Sloan-Kettering Cancer Center has fallen from roughly 40 a few years ago to just 12 last year. "You can't expect people to go into a field knowing they could be pulled into court for 10% of the cancer patients they see," Dr. David Dershaw, Sloan-Kettering's director of breast imaging, said.
Looking Ahead
In response to concerns over the lengthy scheduling delays and staffing shortages, Sen. Tom Harkin (D-Iowa) is expected to introduce a bill this week that would "boost payments for mammograms and provide incentives" for radiologists to remain in the field. Another proposed solution is to train radiology technicians to read mammograms, though the suggestion has been met with some hesitation from professionals unwilling to "stake the lives of millions of women on mammographers who are not doctors." Meanwhile, some say the situation may not be "so dire." Fran Visco, head of the National Breast Cancer Coalition, said, "We're not sure if it's a crisis or if it's something generated by the radiologists' trade association." Time reports that the American Cancer Society and the Society of Breast Imaging are currently analyzing data from a recent survey of radiologists that may shed light on the trend (Gorman, Time, 3/12 issue).
