Screening versus diagnostic mammography

Malpractice issues in radiology: medicare compliance versus standard of care conformance--real or imaginary conflict?

Plaintiff's Attorney (Pl Att:: Doctor, the record shows that the patient was referred to the hospital's radiology department by her gynecologist for a screening mammogram. The record also shows that when completing the mammography information form, the patient wrote that she had a lump in her left breast, correct? Defendant Radiologist (Df Ra:): Yes. Pl Att: But your technologist performed, and you interpreted, a screening mammogram. Doesn't the radiology standard of care require you to do a diagnostic mammogram when the patient has a breast lump? Df Ra:: Well, normally yes, but if it's going to be a diagnostic mammogram, then the referring physician has to order it. In this case our tech called the gynecologist and asked him whether he wanted to order a diagnostic study, and he said no, he didn't feel the lump, and that we should only do a plain screening mammogram. Pl Att:: Please explain something. You're agreeing that a woman with a breast lump should have a diagnostic mammogram, but you are saying that you didn't do one because the patient's physician wouldn't order it? Don't you have a duty to do the diagnostic mammogram in a case like this on your own, without having to ask permission from the patient's gynecologist? Df Ra:: Only the treating physician can change a screening mammogram into a diagnostic mammogram, and I am not the treating physician. If I went ahead and did a diagnostic mammography examination on my own, it would be Medicare fraud, and our hospital's compliance officer says it could result in our hospital being fined and thrown out of the Medicare program. Pl Atty: What prevents you then from recommending-not ordering, but just recommending-a diagnostic mammogram in your report, because the patient says she's got a lump? Df Rad: Well, according to our hospital's compliance officer, that would also be fraud.

Clinical breast examination practices among women undergoing screening mammography

PURPOSE

To determine the proportion of women who underwent clinical breast examination (CBE) within 12 months before undergoing screening mammography and to examine which factors, if any, were associated with having undergone CBE within 12 months before screening mammography.

MATERIALS AND METHODS

A cross-sectional study of 1,135 women presenting for screening mammography was conducted with a self-administered questionnaire. Data were collected regarding sociodemographic information, health care provider information, breast self-examination practices, and CBE history. Data were analyzed with the chi(2) test of independence.

RESULTS

One hundred forty (38.5%) of 364 nonwhite women and 366 (57.4%) of 638 white women reported having undergone CBE 12 months before screening mammography. This association between race and CBE was statistically significant before (P <.001) and after adjusting for education, age, and type of referring physician (P <.001). There was a statistically significant association between undergoing CBE within 12 months and age (P <.001), type of referring physician (P <.001), and education level (P <.001). Health insurance status was associated with having undergone CBE within the past 12 months, but it was not a statistically significant association after controlling for race.

CONCLUSION

The proportion of women who undergo comprehensive breast cancer screening differs by race, education level, and type of referring physician.

Providing professional mammography services: financial analysis

PURPOSE

To perform a financial analysis of mammography services to determine whether the key underlying economic drivers of this service are aligned with the public's expectations.

MATERIALS AND METHODS

The financial status of mammography services at seven university-based programs was assessed by using an extensive financial survey encompassing revenue, direct and indirect costs, and volume data for 1997 and 1998. At one of the institutions, an activity-based costing analysis was performed by procedure type: screening mammography, diagnostic mammography, breast ultrasonography, interventional procedures, and review of outside mammograms.

RESULTS

All seven institutions incurred losses in the professional component of mammography services. The underlying financial problem was a negative contribution margin (total mammography revenues minus direct expenses). The driver of the financial loss was the volume of diagnostic mammograms, which generated a loss per procedure. Diagnostic mammogram volume drove the mammography full-time equivalent count (P =.039) and was highly and negatively correlated with contribution margin (P <.001).

CONCLUSION

The reimbursement rate for mammography procedures, especially diagnostic mammography, needs to be increased to reflect the current reality of the resources necessary to maintain the accessibility and accuracy of this evolving mix of clinical services.