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MEDICARE MAMMOGRAPHY SCREENING REIMBURSEMENT INCREASE

This article was originally published in The Gray Sheet

Executive Summary

MEDICARE MAMMOGRAPHY SCREENING REIMBURSEMENT INCREASE is not a "cost effective" method for promoting greater use of mammography screening, the General Accounting Office says in a recent study. The congressional research organization maintains that an increase in mammography screening fees would lead instead to the proliferation of unneeded low-volume mammography machines, which, in turn, could "increase the unit costs and prices for mammograms" and potentially "reduce the availability of affordable mammography services." Conducted at the request of Rep. Pete Stark (D-Calif.), the GAO study was designed to determine whether a higher rate of reimbursement for mammography screening would encourage more Medicare-eligible women to undergo the procedure. Medicare has been providing coverage for screening mammography since January 1991; however, only a fraction of eligible women have made use of the service. According to the Health Care Financing Administration, for the 19 mil. women who qualified for Medicare- covered mammography screening in 1991, there were about 670,000 screening mammograms conducted during the year. HCFA had projected that about 4.9 mil. Medicare screening mammograms would occur in 1991. Explaining its finding that a reimbursement increase is not the best approach to promote greater use of mammography screening, GAO notes that a higher fee would require Medicare beneficiaries to pay a higher copayment. In addition, "increasing the Medicare fee cap from [the current] $58 to as high as $80 to $100 could encourage more screening mammography units in physicians' offices, but, based on our prior work and studies by others, we believe that those additional units would constitute expensive, excessive capacity." GAO adds: "Having more screening mammography machines in physicians' offices might increase convenient access to this service for some women, but there is little evidence that Medicare-eligible women would benefit" because only 2% of office visits by Medicare patients are to obstetric/gynecology practices, which "have most of the screening mammography machines in primary care settings." An increase in the Medicare fee limit also could limit access for non-Medicare patients, GAO concludes. Because private insurers likely would mimic the Medicare increase, and "patient volumes at existing units would likely decline with the increasing number of facilities,...uninsured and low-income women would face higher costs that could further discourage them from seeking a screening mammogram." GAO maintains that stepping up education of women and physicians is more likely than a fee increase to expand mammography screening of Medicare patients. "Recent studies show that educating women about the importance of periodic screening and encouraging physicians to regularly refer women to screening facilities have a strong potential for increasing mammography use. The most common reasons women give for never having had a mammogram are that they did not know they needed one and that their physician had not recommended one," GAO notes. In a response to the report, HHS says that it agrees with GAO's conclusions and recommendations and pledges to "continue to review our education programs and coordinate national public and provider information efforts that are targeted to the Medicare screening mammography benefit."

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