Digital mammography payments bill splits vendors and ACR

Proposals in Congress to increase payments for digital mammography procedures have led to a split between the American College of Radiology on one side and vendors and an advocacy group on the other.

With Congress poised to adjourn this week, the possibility that language allowing an increase in payments for digital mammography procedures could be approved remains alive. Besides the ACR opposition, however, the proposal could be sidetracked by end-of-the-year budget disputes between the Clinton White House and the Republican Congress.

Bills that would allow payments for new CAD technologies that help detect breast cancer in asymptomatic women to be set at 150% of the payment for film-based screening were introduced in both the House of Representatives and the Senate just last month. Backing them were GE Medical Systems, which has a digital mammography system on the market, and Fischer Imaging, which has one in development, said Fischer CEO Morgan Nields. The Susan G. Koman Breast Cancer Foundation, a patient advocacy group, also supported the legislation.

(GE spokesperson Gary Sheffer declined to confirm Nields's statement, saying the company has a policy of not discussing its lobbying activities or pending legislation.)

But the ACR, in a letter sent to the House earlier this month, strongly opposed the adoption of legislative language that it said would tie screening mammography payments to a particular technology, especially one that the ACR said has not been independently and scientifically proven to be better than present methods.

"Adoption of this provision could be seen to indicate that corporate interests, rather than scientific study, would be allowed to determine medical appropriateness," said a letter to Congress from Dr. Harvey L. Neiman, chairman of the ACR board of chancellors. "(The ACR) believes that independent researchers and physicians should advise the Congress on the appropriateness of mammography screening procedures."

Neiman said increasing payments for screening mammography needs a close look, and the ACR will work next year with Congress and other parties to address this issue, including the role of new technologies.

"We consider this measured approach to be far better than allowing a last-minute special interest provision to take funding which could be used to benefit all women who need mammography services," he said.

One possible result of the ACR's opposition would be to leave the Health Care Financing Administration with more power to set reimbursement rates for digital mammography, according to Fischer's Nields. Getting payment increases under that mechanism could take longer, and the outcome could be less desirable than having the matter determined in Congress, he said.

"Congress is sympathetic to these issues and the place to get the reimbursement fixed is in Congress. I'm somewhat puzzled by the ACR's action," Nields said.

The proposal's fate remained uncertain as SCAN went to press. The original House and Senate bills were pending and probably will not be acted upon before Congress adjourns. But the digital mammography reimbursement provision was added to a larger $26 billion to $28 billion supplemental Medicare funding measure. The White House threatened to veto the funding measure, charging that it was too generous to HMOs that cover only a minority of Medicare patients.

The actual language of the Medicare legislation has not been disclosed. But if the mammography provision follows House and Senate bills introduced in September (HR 5172 and S 3112), it would allow a $155 payment for digital screening mammograms performed beginning in January, with $130 for the technical component and $25 for the professional component.

Congress recently approved a 2% increase in payments for traditional screening mammography (see related story, page 4), bringing the total to $69.23, split $42.92 for the technical component and $26.31 for the professional component.

Diane Balma, senior counsel and director of public policy for the Susan G. Komen Foundation, said the foundation supports higher payments for all screening mammography and decided to support a special boost for digital mammography several months ago.

"We believe it has amazing potential. It was as good as standard mammography and members of Congress were afraid to go forward on that basis alone," she said. "Our feeling is that, as it develops, digital mammography has the potential to find lumps that might be missed by standard mammography. It also offers the ability to transfer images from remote rural areas to places where they can be read, making access to mammography easier."