clinic and more than $105 in a hospital.d For high volume settings, even relatively small shortfalls for a particular procedure can add up to large operating deficits. This is compounded in settings that are dedicated to providing a single procedure because there are no opportunities for cost recovery on other, profitable procedures.

A financial analysis of seven university-based breast programs reported that they all incurred losses in the professional component of mammography services.4 The driver of the loss was diagnostic mammograms.37 However, it should be noted that because women often seek out university-based programs for second opinions or difficult diagnoses, such programs are likely to conduct a larger proportion of diagnostic mammograms as compared with community facilities (Dieter Enzmann, personal communication).

Increasing Demand for Breast Imagers

The term “crisis” is routinely used in the radiology community to describe the shortage of breast imagers. Based on U.S. population estimates, 1.25 million additional women become age eligible for recommended mammography screening each year, while only about one to three dozen breast imaging subspecialists enter the profession each year (Priscilla Butler, ACR, personal communication). Although only about 12 percent of all mammograms are interpreted by breast imaging subspecialists (Barbara Monsees, personal communication), they spend more of their time doing breast imaging than other radiologists and tend to be more proficient. Thus increasing their ranks may not only help meet the growing demand for screening mammograms, but also improve the quality of breast image interpretation.

Mammography here is pretty awful. Five centers closed in 18 months and we’re working very hard, too hard. Two technologists put in their notice and the three of us part-time mammographers may have to leave because the insurance company is putting an extra charge to read mammography—i.e., my premium and hence, tail coverage will cost more than my husband, who is full time. Pretty crazy. It will take all of us leaving Florida mammography to make a change.

Anonymous Florida radiologist

January 2004

d  

Medicare reimbursement for mammography services comprises a professional component, the amount paid for the physician’s interpretation of the results of the examination, and a technical component, the amount paid for all other services (including technician and equipment costs).



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