'Economically unsustainable': How Medicare reimbursements hinder adoption of latest mammo technology
A new paper published on October 11 in Radiology highlights the relationship between race and access, or lack thereof, to evolving mammographic screening techniques.
The paper, which focused on the Medicare population from 2005 to 2020, revealed that Black women had less access to newer mammographic technology than their white peers, even when their exams took place within the same institution [1]. Although cancer detection rates among Black and white women are similar, Black women are 40% more likely to die from breast cancer, in part, due to the stage at which their cancer is detected—an occurrence that is inevitably impacted by access to newer screening technology, authors of the new study suggested.
The analysis included more than 4 million Medicare claims during the time period, during which two significant transitions in breast cancer screening occurred—from screen-film mammography (SFM) to full-field digital mammography (FFDM), and from digital mammography to digital breast tomosynthesis. Despite these impactful technological strides, study co-author Eric W. Christensen, PhD, principal research scientist in health economics for the Harvey L. Neiman Health Policy Institute, shared that not everyone benefits from improvements that newer screening methods provide, and that insurance reimbursements could be to blame.
“Inequities result when lower payments make technology investments economically unsustainable for practices that serve higher proportions of Medicare patients,” Christensen said in a statement.
The payments Christensen is referring to are Medicare reimbursements dictated by the Centers for Medicare and Medicaid Services (CMS). Private insurers offer reimbursements 1.2 to 1.8 times higher than public insurers such as Medicare, which exacerbates healthcare disparities in underserved areas where many utilize public insurance.
According to the new data provided by Christensen and colleagues, although these gaps in care do appear to soften over time, this does not occur at an equitable pace.
For example, in 2005 the odds ratio (OR) of Black women receiving digital mammography instead of SFM was .80 compared to white patients. This remained the case until 2009. When the use of DBT exams began to take precedent over DM, the trend continued, with Black women statistically less likely to undergo DBT over DM than white women.
In 2011—well into the digital era—Black women were 3.8 percentage points less likely to receive a DM than white women. However, in 2016, that figure decreased to 1.2 percentage points less, indicating a lag in uptake among different races and slower adoption of new technology in underserved regions. The authors noted that the transition from DM to DBT is still underway, and like previous transitions, the gaps in care appear to be closing over time.
The authors of the study suggested that changes in incentive and reimbursement policies could help to expedite these transitions in screening with newer, more efficient technologies.
“Current reimbursement contributes to inequity because locating new technology in facilities that serve patients with public insurance, Medicare and Medicaid, is not economically sustainable,” Christensen said. “CMS can create economic incentives to lessen disparities through reimbursement that is either comparable to private payers or that more directly incentivizes adoption of newer technology in underserved communities.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.