Oak Brook, Illinois. – In the Medicare population from 2005 to 2020, black women had less access to new mammography techniques than white women, according to a study of more than 4 million claims published in the Journal of Radiology, This is true even when mammograms are performed at the same institution. Radiological Society of North America (RSNA).
Black women are 40 percent more likely than white women to die from breast cancer, even though black and white women have about the same cancer incidence.
Since 2000, mammography for breast cancer screening has undergone two major transitions: first, from screen film mammography (SFM) to full-field digital mammography (FFDM), and second , the transition to digital breast tomosynthesis (DBT). While these advances in early detection mean more women can survive breast cancer, not all women have equal access to these new technologies.
More fully, initial Medicare coverage could help access new breast cancer screening technologies in underserved areas and reduce the duration of relevant racial and regional disparities in breast cancer care. The disparity is temporary and will eventually ease as technology dissipates from wealthy areas with more private insurance coverage to underserved communities where public insurance may be more prevalent. However, this process has been extended as Medicare reimbursements are 1.2 to 1.8 times lower than private insurers.
“In an increasingly competitive healthcare environment, the Centers for Medicare and Medicaid Services (CMS) cannot expect healthcare providers to ignore these competencies and participate in health equity efforts without considering technologies and services where reimbursement is low. the economic consequences,” said study co-author Eric W. Christensen, Ph.D., principal research scientist in health economics at the Harvey L. Neiman Institute for Health Policy and Adjunct Professor of Health Services Administration at the University of Minnesota, Minneapolis. . “Inequities result when lower payments make technology investments unsustainable in practices that serve a higher proportion of Medicare patients.”
The study is a collaboration between the Neiman Institute for Health Policy and the Radiological Health Equity Consortium (RHEC), a coalition of 10 major radiology organizations that aims to positively impact health care equity.
“The Radiology Health Equity Alliance understands the integral role that research plays in addressing health disparities,” said study co-author, SUNY Downstate Health Sciences Department of Radiology Associate Professor of Clinical Radiology, MD, MBA said Jinel Scott, and chief quality officer at New York Health and Hospitals/Kings County in New York City. “Our paper is an example of the coalition’s goal to evolve from primarily descriptive analysis to predictive and ultimately prescriptive approaches to combat patient outcomes related to inequities in healthcare delivery.” General Director of RSNA Board of Directors ,PhD. Scott is the RSNA representative at RHEC.
For this study, Dr. Christensen, Ph.D. Scott and colleagues set out to study the relationship between the ethnicity of women undergoing mammography services and the use of new mammography techniques.
Researchers conducted a retrospective study of women with Medicare fee-for-service coverage who underwent mammograms between January 2005 and December 2020, using all Medicare fee-for-service 5% sample of beneficiaries.
Researchers analyzed 4,028,696 institutional mammography claims for women (average age 72). Within one institution, the odds ratio (OR) for black women who underwent digital mammography but not SFM in 2005 was 0.80 compared with white women. These differences continued into 2009. Compared with white women, Black women were less likely to use DBT within the institution from 2015 to 2020 (OR: 0.84).
Across institutions, there were racial disparities in the use of digital mammography, with black women 3.8 percentage points less than white women in 2011, then falling to 1.2 percentage points in 2016. These results show the temporary nature of these differences, which appear to be subsidizing, although the transition to DBT is still underway.
The study found evidence of racial disparities in the years following the introduction of newer mammography techniques. These differences include differences within institutions and between comparable institutions. According to Dr. Christensen, advocating for preferential reimbursement and incentives may reduce these disparities if you keep up with evolving technology.
“Current reimbursement creates inequity because it is not economically sustainable to deploy new technology in facilities serving Public Insurance, Medicare and Medicaid patients,” he said. “CMS can create economic incentives to reduce disparities through compensation comparable to private payers or more directly incentivizing underserved communities to adopt new technologies.”
The researchers stipulate that organizations have a responsibility to provide care equitably. Their ability to do so will be enhanced by promoting reimbursement policies that invest in sites that serve disadvantaged groups. The fact that racial disparities in digital mammography are temporary and subside as new technologies become available supports the real potential for such policy changes to mitigate transitional disparities associated with technological advances. Equitable access to breast cancer screening has the potential to improve population health, and supporting health policy could push the U.S. healthcare system closer to that goal.
RHEC includes RSNA, ACR, American Board of Radiology, Radiology Branch of the American Medical Association, Society of Collegiate Radiologists, National Medical Association Branch of Radiology and Radiation Oncology, Association of Academic Radiology Department Chairs, Society of Interventional Radiologists, Nuclear Medicine and Molecular Imaging and the American Association of Medical Physicists. Several other groups, including professional and state radiology organizations, have joined the initiative as coalition partners.
“RSNA supports RHEC’s work and values a cross-social approach, providing members with the information and tools they need to become advocates for the communities they serve,” said Dr. Scott said.