Screening Mammography

Higher Medicare Payments Could Increase Costs Without Increasing Use Gao ID: HRD-93-50 April 22, 1993

Increasing the cap on Medicare payments to encourage physicians to offer mammography in their offices is not a cost-effective way to expand the use of screening mammography. A study by the Department of Health and Human Services shows that the United States already has more than enough mammography machines, even if all women received screening mammograms at intervals suggested by the National Cancer Institute. A substantial increase in the Medicare payment to support more low-volume machines is likely to increase excess capacity, increase prices for mammograms, and reduce the availability of affordable mammography services. In addition, inconsistent guidelines issued by the Health Care Financing Administration and differing Medicare regulations for diagnostic and screening mammography have led to confusion about the appropriate billing procedures for screening mammography provided under package leasing arrangements.

GAO found that: (1) it would not be cost-effective to attempt to increase mammography use by increasing the Medicare payment cap for screening mammograms, since low-volume machines' higher unit costs could discourage some women from obtaining mammograms because of higher copayments; (2) educational programs and encouraging regular physician referrals to screening facilities are more promising and cost-effective approaches for increasing mammography screening; (3) enough mammography screening capacity exists without physicians setting up additional, higher-cost machines in their offices; (4) some physicians are confused by the Health Care Financing Administration's (HCFA) inconsistent billing guidance and differing Medicare regulations for diagnostic and screening mammography; and (5) in 1990, HCFA adopted a more burdensome billing procedure that requires physicians to bill Medicare and their patients separately for the professional and technical components of their mammography services, which results in four bills for each procedure.

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