Congress debates payment boost for screening mammography

Two House bills that call for an increase in screening mammography payments have picked up support on both sides of the aisle. The two measures, which propose raising the reimbursement rate from the current $69 to $90, are based on Senate bill 548, introduced in mid-March by Sen. Tom Harkin (D-IA) and Sen. Olympia Snowe (R-ME). The Harkin-Snowe bill, which had five early cosponsors, now has 11.

The need to increase payments is obvious, according to Rep. David Hobson (R-OH), who introduced the Medicare Mammogram Access Protection Act of 2001 (HR 1328) in the House.

“The government is reimbursing less for a mammogram than anyone would pay on service calls for their refrigerator or television,” Hobson said.

A boost in payments could encourage healthcare providers to invest in new equipment beyond the level mandated by the Mammography Quality Standards Act of 1992, which sets performance requirements for mammographers. Many sites are expected to upgrade their equipment before the Oct. 28, 2002, deadline set by MQSA, leading to a short-term pop in equipment sales. A substantial number of sites, however, are expected to stop providing mammography, because compensation does not justify necessary capital and operating expenses. Their exit could exacerbate the already long delays of weeks or months that many women must endure to receive screening mammograms (SCAN 4/11/01). Raising payments for these exams could help relieve availability problems while increasing demand for mammography equipment-a win-win-win situation for patients, providers, and manufacturers.

Recent progress on Capital Hill is encouraging. Since the April introduction of HR 1354 (the Assure Access to Mammography Act of 2001), 26 new cosponsors have joined Rep. Peter King (R-NY) and Rep. Anthony Weiner (D-NY), who introduced the bill, bringing the total number of cosponsors to 49. HR 1328 (the Medicare Mammogram Access Protection Act of 2001) has also gained support. This bill, proposed by Hobson, has picked up 11 new cosponsors, bringing the total to 14 since its introduction earlier this year.

All the proposals call for increased reimbursement. They differ, however, on a number of details. Like S 548, Hobson’s HR 1328 would delay placing screening mammography reimbursement into the Medicare fee schedule, which is not in Congress’s hands, until Jan. 1, 2003. It would also commission a Medicare Payment Advisory Committee (MedPAC) study to review current reimbursement rates for all screening procedures under Medicare.

Unlike S 548, the Hobson bill includes no funding for additional radiology residency slots and allied health personnel. Nor does the Hobson bill include a General Accounting Office study and report on Medicare reimbursement for gender-specific services that is contained in S 548.

The King-Weiner bill (HR 1354) is virtually identical to S 548, although it adds a provision in the GAO study section regarding payment amounts for inpatient hospital services or covered skilled nursing facility services that are gender-specific.

The chance that Congress will soon pass some form of legislation requiring an increase in mammography payment is underscored by the depth of interest in this medical practice among federal legislators. Another proposed piece of legislation, the Mammogram Availability Act of 2001 (HR 292), introduced by Rep. Jerrold Nadler (D-NY) in January, would require insurers that currently reimburse for diagnostic mammography to cover annual screening mammograms for women age 40 and older as well. The measure would also prohibit insurers from denying coverage for annual screening mammography on the basis that the procedure is not medically necessary or not referred. The legislation recently picked up two cosponsors, both Democrats.