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In recent years, many mammography facilities have been forced to provide fewer mammograms to patients, or in some cases, close their doors completely. At the annual meeting of the Radiological Society of North America (RSNA), held in Chicago this November, a panel of physicians pointed to low reimbursement rates and threats of malpractice as the primary problems for mammography facilities. As more and more women begin to get annual mammograms at age 40, the amount of time women must wait to get a mammogram from the time they schedule an appointment is turning into weeks or even months. Many physicians fear that scheduling frustrations will cause many women to forego their annual mammograms. According to Dieter Enzmann, MD, chairman of the department of radiology at Northwestern University Hospital in Chicago, the reimbursement rate for mammography from the U.S. government (through Medicare) and private insurance companies is so low that many facilities lose hundreds of thousands of dollars annually by providing mammography services. The average Medicare reimbursement rate for screening mammography is approximately $68 and the reimbursement rate for diagnostic mammography is approximately $81. However, for women who have to pay for mammograms themselves, a screening mammogram costs approximately $100 and a diagnostic mammogram may cost over $200. The low reimbursement rate has caused some mammography facilities to close down completely. Even the New York University (NYU) Medical Center had to shut down one of their two mammography facilities last year due to financial difficulties. According to Gillian Newstead, MD, director of breast imaging at NYU, it was cheaper to close the facility and just pay the rent on the office rather than keep the facility open and lose money by providing mammograms. At the RSNA conference, Dr. Enzmann presented his study on seven U.S. academic institutions that each performed between 10,000 and 50,000 mammograms per year. Every facility experienced a loss in revenue on mammography services, said Dr. Enzmann. The study will be published in Spring 2001, and the data will be used by physicians to try to persuade the government to raise its Medicare reimbursement rates for mammography. Low reimbursement rates are not the only problem for mammography facilities, though. At the RSNA conference, physicians said that fears of malpractice are contributing to fewer applicants for fellowships in mammography. While mammography can detect approximately 85% of breast cancers, it can miss up to 15%. The chances of missing breast cancer are greater in younger women, who usually have dense breast tissue. According to the study, the number of applicants for fellowships in mammography fell 75% at NYU, and the number of applicants at Memorial Sloan-Kettering Cancer Center in New York fell from 40 to 12 in one year. As these problems persist, the demand for mammography continues to grow. It is estimated that approximately one million women will turn 40 this year and should begin receiving annual screening mammograms. Physicians also credit the rising demand for mammography to breast cancer organizations who have advocated screening measures to help detect breast cancer in its earliest stages. Approximately 32 million mammograms are performed annually in the U.S. Unfortunately, many women are finding that they must wait several weeks or even months to receive a mammogram when they call to schedule one. David Dershaw, MD, director of breast imaging at Memorial Sloan-Kettering Cancer Center, estimates that the wait time for mammography may have increased by as much as 50% in recent years. Even women who need diagnostic mammograms often have to wait several weeks to receive the exam. Physicians fear that the hassle of scheduling a mammogram may cause some women to decide not to have the potentially life-saving exam. Yet despite the problems that exist for mammography facilities, Dr. Enzmann said that the industry is not in a crisis at the moment in terms of access to mammography. However, reimbursement rates must be raised so that facilities can continue to provide mammography services in the coming years. The physicians hope that public education efforts will help initiate changes in the field of breast imaging. The American Cancer Society, the American College of Radiology, the American College of Surgeons and the American Medical Association all recommend that women begin receiving annual screening mammograms at age 40. Guidelines for early breast cancer detection:
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