As Demand For Screenings Increases, Mammography Centers Close Because of Low Reimbursement, Lack of Technicians

Saying that they "are losing money on each" x-ray, existing Maryland mammography centers are closing, and with few new centers opening to replace them, many women's health advocates fear that women may have "increasing difficulty" obtaining the procedure, the Baltimore Sun reports. In 2000, 167 facilities in Maryland performed mammographies, while only 150 centers offer mammography this year, according to the American College of Radiology. Nationally, the number of mammography centers has fallen from 9,873 in March 2001 to 9,534 in October 2001. The problem, many radiologists say, is that "new centers aren't opening fast enough" to adequately treat the demand, mainly because of low reimbursement and practioners' lack of interest in the field. Medicare -- which reimburses about 20% of all mammograms -- this year began calculating mammogram rates based on the physician's time, cost of the equipment and malpractice insurance costs -- "in the same way as other Medicare payments," resulting in a 28% rate increase for 2002, from about $69.23 to $88.50. However, Maryland HMOs pay an average of $58 for a screening mammogram, and indemnity and preferred provider plans pay "a few dollars" less than HMOs. Subsequently, radiologists say that low rates are "discouraging doctors" from choosing to specialize in mammography. Dr. R. James Brenner, chair of the College of Radiology's task force on mammography practice, said, "[T]here are disincentives to expand resources which translates into access and into whether people choose to specialize in this field," adding, "Ultimately, that may translate into missed cancers or unnecessary biopsies."

Imminent Crisis?
With 64 million women over the age of 40 -- a number expected to rise 28% over the next two decades -- and the demand for mammograms increasing as more women "heed" recommendations for annual screenings, some question whether the closings will affect access. Representatives from Advanced Radiology, which along with American Radiology provides the majority of mammography in Baltimore, say that the Baltimore-area waiting period for a mammography screening currently is three months. Dr. Gina Sager, breast surgeon at Franklin Square Hospital, says that some studies demonstrate "longer waits can discourage women from getting annual screenings." According to Dr. Robert Smith, director of the American Cancer Society, there is not enough data to point to a current crisis, "but we could very soon find ourselves in the midst of a crisis where women can't get access to mammograms" (Salganik, Baltimore Sun, 10/28).