Falling payments may position MRI for primary breast screening

The gulf between payments for mammography and for MRI is narrowing. As reimbursement for these two converges and the technology advances, MRI may begin to challenge x-ray-based imaging as a primary breast screening modality.

“Small MRI devices using open-face magnets allow patients to literally press their chests up against the magnet and the detector coil,” said Robert A. Bell, president of R.A. Bell & Associates, of Encinitas, CA. “Devices like that hold great promise for providing soft-tissue information in the breast. I think this kind of device could get breast images down into the $50 to $60 range.”

Medicare sets the rate nationally for mammography reimbursement. That payment is now at about $70, yet fee-for-service rates in some markets top $200. MRI studies have tumbled into the $300 range in certain areas of the country. Breast MRI on general purpose systems could get down to $250, according to Bell, a figure that might allow it to compete with mammography in certain fee-for-service environments.

One company that has begun marketing an MRI device with potential breast applications is MagneVu of Carlsbad, CA. Its system, designed for orthopedic extremity use, eventually may be used for breast screening, according to the firm.

“We would expect that if protocols are developed using conventional equipment, and the market is developed and initialized there, that we certainly would be able to duplicate (film-screen results),” said Freeman Rose, MagneVu CEO.

The result could be a considerable financial benefit for MagneVu, although Rose would not speculate on possible revenues. Bell could not provide specific estimates but stated that the market is potentially huge.

“This could mean enormous profits for the company, if its technology could be shown to have clinical application in breast screening,” he said.

Agreeing with this suggestion is Joseph Fritz, senior manager for clinical development at Toshiba America Medical Systems, which incorporates a breast coil on its Opart open MRI system. He thinks the expansion of MRI into mammography could have direct impact on general-purpose equipment.

“It could make a substantial change in the volume of sales,” Fritz said.

Even so, challenges remain if MRI is ever to become a front-line breast screening tool. Ease of use, specificity, and per-exam costs would have to improve if MRI is to successfully compete against x-ray-based mammography. And that assessment does not consider any changes or improvements that might be made in x-ray-based imaging.

“We still focus on breast imaging, but so do the manufacturers of mammography systems,” said Anita Bowler, product manager for open MRI at Toshiba. “To predict five to 10 years from now where MRI will be versus where the other modalities will be is hard to do.”