Connecticut’s Dense Breast Legislation Three Years Later

Published on the Oct. 23, 2012, Diagnostic Imaging website

By Whitney L.J. Howell

Connecticut launched its law mandating providers alert women if they have dense breasts and offer supplemental ultrasound screenings three years ago. The road has been rocky — radiologists initially resisted it, the density legislation confused many patients, and few women seemed interested in the secondary scans. But new research shows the law has resulted in more cancers found.

Much discussion surrounded Connecticut’s dense breast tissue law when it passed in 2009, requiring referring physicians to inform women with dense breast tissue that they could benefit from supplemental ultrasound screening. A recent study revealed the law had a slow, but effective, start.

In research published in the October issue of Radiology, investigators from Yale University determined less than 20 percent of women with dense breast tissue opted to have an ultrasound screening after receiving abnormal mammogram results. The retrospective review analyzed the ultrasound results for nearly 1,000 women who underwent the procedure.

Although fewer women than anticipated opted for ultrasound screenings after the law took effect, lead study author Regina Hooley, MD, assistant professor of diagnostic radiology, said giving patients the option of supplemental ultrasound screening after a mammogram was useful. Based on data pulled from the legislation’s first year, her team found additional 3.2 cancers per 1,000 women were discovered using ultrasound.

“These findings are right in the ballpark for the amount of cancers we identify with mammogram,” Hooley said. “Although mammography is the only test with data to show it reduces breast cancer-related mortality, it’s clear, with this study, that ultrasound provides an acceptable cancer detection rate at an acceptable cost.”

In January, Texas enacted its own version of the law, known as Henda’s Law. And, the American College of Radiology anticipated 13 additional states introducing some type of similar legislation during 2012.

According to the study’s cost analysis, each cancer identified via ultrasound cost approximately $60,000. That figure equals roughly $200 per patient, Hooley said. It’s also important to note that Connecticut insurance companies are required, under law, to cover these supplemental ultrasound screenings.

Connecticut radiologist Jean Weigert, MD, who serves as treasurer for the Radiological Society of Connecticut, also tracked supplemental ultrasound screenings in her practice. Her results, she said, are exactly the same as Hooley’s.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/2110186

Radiology: What’s Coming in 2012

Published on the Feb. 16, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

Throughout 2011, most chatter in radiology centered around how healthcare reform would change the industry or how practitioners should manage and use newer modalities. In a look ahead at the next 12 months, many industry luminaries anticipate the same concerns will linger on the horizon even as new ones appear.

Some of the upcoming challenges touch the individual radiologist’s pocketbook; others affect practice. Regardless of the specifics, radiologists will do well to revamp how they view themselves as part of the healthcare system, said James Thrall, MD, Massachusetts General Hospital (MGH) radiologist-in-chief and former American College of Radiology president.

Financial Implications

Radiology’s biggest concern for 2012 is a holdover from last year — bundled payments and reduced reimbursement. Under the proposed accountable care model, radiology reimbursements would be wrapped up in a lump-sum amount that includes facility, physician, and technical payments.

It’s the ambiguity of these packaged payment’s impact that make them the industry’s greatest challenge this year, said, Leonard Berlin, MD, former chair of the professionalism committee with the Radiological Society of North America (RSNA).

Leonard Berlin, MD, former chair of the professionalism committee for the Radiological Society of North America

“There’s no question that there’s been a definite move to decrease reimbursement for radiology at the Centers for Medicare and Medicaid Services,” Berlin said. “All the projections for radiology reimbursement have it falling, meaning that practitioners, for 2012 and beyond, will need to find a way to maintain and manage a workload that is sometimes heavier for less money.”

The ACR is also concerned about reduced payments. Currently, the organization’s No. 1 priority is working with Congress to extend the temporary fix to Medicare’s sustainable growth rate, the formula used to control healthcare spending. The stop-gap measure, enacted in December 2011, averted a 27 percent physician payment reduction, and the ACR would like to extend the fix permanently.

“We’re also watching carefully to see if we can stop the Centers for Medicare and Medicaid Services from making any multiple procedure payment reductions,” said Cindy Moran, ACR’s government relations assistant executive director, referring to cuts in payment when two or more codes are performed to the same patient by the same physician during a single session. “But we are also assuming, with this being an election year, that we might be faced with a lame duck Congress.”

Changes could also be coming to codes that routinely appear together, said Maurine Spillman-Dennis, ACR’s senior director of health policy. CMS is analyzing whether procedure codes that are often linked 50 percent, 75 percent, and 90 percent of the time can be bundled, reducing overall reimbursement for those services.

“We are involved in an evolution toward a new payment model. The bottom line is that healthcare is turning away from the fee-for-service system and moving toward capitated services,” Spillman-Dennis said. “It will be a challenge for radiology to fight under this new care delivery model and make sure its practitioners are paid for services provided.”

To read the remainder of the article: http://www.diagnosticimaging.com/practice-management/content/article/113619/2033254