Since its introduction in the Senate in March 2001, the Assure Access to Mammography Act of 2001 (S 548) has seen its fortunes wax and wane with the political realities facing the country. Like other health legislation, stalled because of the September 2001 terrorist attacks in New York City and the District of Columbia, S 548 may have one last chance for passage by the 107th Congress before this November’s elections.
The Assure Access to Mammography Act was written by Sen Tom Harkin (D-Iowa), who introduced the bill with Sen Olympia Snowe (R-Me). Identical measuresHR 1328 and HR 1354were introduced in the House at the same time as S 548. The House bills were included in its omnibus Medicare Modernization and Prescription Act of 2002 (HR 4954), which was passed on June 28.
Complicating passage of health legislation in the Senate was the defeat of dueling prescription drug bills on July 23, which has delayed the debate on its Medicare modernization bill, the likely destination for the provisions in S 548.
The Senate bill builds on and addresses some of the shortcomings of the 1992 Mammography Quality Standards Act (MQSA), including the costs associated with mammograms. Reimbursement for mammography, which has been removed from the statute, continues to be low. The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule setting screening mammography reimbursement at $81.81, $8.19 lower than the reimbursement rate set in legislation. “Since [the introduction of the bills,] we’ve done an economic survey finding that the cost of performing screening mammography in hospitals is quite a bit higher than it is in private offices,” says Charlie Showalter, senior director of government relations for the American College of Radiology (ACR). “While a little bit low, [the current rate] is in the ballpark for the costs in private offices. Our survey showed that the cost in hospitals was more on the order of $125. So we’ve been talking with various [Congressional] staffers about perhaps establishing some sort of two-tiered reimbursement system.” At press time, no amendment for a two-tiered payment system has been included in either the House bill or any of the proposed Senate legislation.
S 548 and the House versions of the bill also address the ongoing radiologist shortage, creating three new spaces for radiology residents in all radiology residency programs. Improving reimbursement and creating more radiology training slots go hand-in-hand, says Showalter. “If you have a shortage of radiologists, then radiologists pretty much can choose what career path they want to take,” he says. “Most will not choose an area that is being under-reimbursed.”
There has been an erosion in the number of facilities performing screening mammography. According to Showalter, there are now 500 fewer Food and Drug Administration-approved facilities than there were 18 months ago. “There are areas where there is a real shortage,” he says. “The April General Accounting Office report identified someBaltimore being one. And certainly other anecdotal evidence suggests that in the New York City you can expect a long wait if you try to schedule a screening mammography exam. [The ACR] is concerned this is going to develop into an overall access issue, and we think if we can fix the issue early on, we can head that off&.It’s not so much the physician reimbursement, it’s the technical part of the reimbursement that goes to the facility that’s at issue. If a facility closes, [there’s no need for] radiologists to read mammograms, so whether or not we have the radiologists to do it&you also need the facilities to be operational. Even if other facilities add additional capacity, the geography has changed, and for some people it might become quite inconvenient to go to the [nearest] facility because [it’s too far away].”
Though the House version of the Harkin-inspired bill was included in the omnibus HR 4954, S 548 has yet to be included in any Senate-sponsored legislation. However, the ACR has received assurances that there will be a mammography provision in any Senate Medicare bill, but it may bear little resemble to S 548 as it was introduced in March 2001. “It could be that there’s an agreement that physician payment has to be done clean’ as they call it, then we always have the omnibus bill at the end of the year to attach it to,” says Joshua Cooper, director of congressional relations for the ACR.
Cooper adds that it is highly unlikely that S 548 will be passed “clean.” “It’s the type of bill that would be wrapped up in other legislation,” he explains. “What the conventional wisdom [says] is the House has passed its prescription drug bill, the Senate may or may not pass its prescription drug bill, [and, if they do,] they will be, in theory, different enough and there will not be enough time before the elections for the prescription drug bills [to be reconciled, and they will] evaporate. Then Congress can concentrate on the Medicare provisions [which] will be put on some type of omnibus bill at the end of the session, which includes all the appropriations bills that have not been addressed yet, so that’s probably where S 548 will be tacked on.”
With the November Congressional elections looming, many Senators’ political futures are riding on the passage of a health reform bill. Cooper believes that there is a 75% chance that it will be passed prior to the election. If not, he says, there may be a lame duck session in December and the Medicare legislation, including S 548, could be taken up then.
Following the July 23 defeat of the Senate prescription drug bill, Harkin’s and Snowe’s offices could not be reached for comment on the future of S 548.
CA Wolski is associate editor of Decisions in Axis Imaging News.