Digital breast tomosynthesis has developed into a widely-used medical imaging procedure that contributes to fewer redundant tests and reduced health care costs. However, as the industry focuses on quality-driven reimbursements for physicians, changes need to be made in order to cover the service.
AuntMinnie.com reported that the American College of Radiology is urging the U.S. Centers for Medicare and Medicaid Services to include breast tomosynthesis in its coverage. Currently, women who undergo the exam have to pay out-of-pocket expenses, despite the procedure’s growing popularity over conventional mammography.
In addition to CMS, the ACR wants private insurers to cover tomosynthesis in the hope of expanding its benefits, making it more accessible for a larger range of patients. The statement, released on July 22, 2014, notes that digital imaging provides advantages over film screen mammography – specifically, tomosynthesis’s association with higher cancer detection and lower recall rates.
However, more research is needed to assess the technology’s impact on long-term clinical outcomes. If radiologists were to be reimbursed for exams, there would be more inclination to conduct in-depth studies on the effects of breast tomosynthesis.
Digging into the facts
A recent study, published last month in the Journal of the American Medical Association, examined the benefits of including tomosynthesis with digital mammography. Researchers led by Sarah Friedewald, M.D., from the Advocate Lutheran General Hospital in Park Ridge, Illinois, used clinical data from 13 health centers that included more than 450,000 breast exams. Roughly 62 percent of the tests were digital mammograms, while the remainder added on tomosynthesis.
The results indicated that the technology allowed for the detection of one extra cancer for every 1,000 breast exams performed. Digital tomosynthesis also caused a significant reduction in callbacks for further procedures, which cuts costs for both patients and facilities, FierceMedicalImaging explained.
“To facilitate such large-scale research, the technology must be widely available,” ACR said in its statement, quoted by AuntMinnie.com. “The college urges the [CMS] and private insurers to facilitate access to these exams by covering beneficiaries for tomosynthesis – now that it has been shown to improve key screening parameters compared to digital mammography.”
Last November, CMS stated that tomosynthesis was a component of digital mammograms and is not billed separately from the procedure. Medicare currently pays the same rate for both exams, even though tomosynthesis costs more than traditional scans. CMS aims to issue a decision on coverage in the fall.
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Ronny Bachrach
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