Community-based mammography practice: services, charges, and interpretation methods

Abstract

Objective: The purpose of our study was to accurately describe facility characteristics among community-based screening and diagnostic mammography practices in the United States.

Materials and methods: A survey was developed and applied to community-based facilities providing screening mammography in three geographically distinct locations in the states of Washington, Colorado, and New Hampshire. The facility survey was conducted between December 2001 and September 2002. Characteristics surveyed included facility type, services offered, charges for screening and diagnostic mammography, information systems, and interpretation methods, including the frequency of double interpretation.

Results: Among 45 responding facilities, services offered included screening mammography at all facilities, diagnostic mammography at 34 facilities (76%), breast sonography at 30 (67%), breast MRI at seven (16%), and nuclear medicine breast scanning at seven (16%). Most facilities surveyed were radiology practices in nonhospital settings. Eight facilities (18%) reported performing clinical breast examinations routinely along with screening mammography. Only five screening sites (11%) used computer-aided detection (CAD) and only two (5%) used digital mammography. Nearly two thirds of facilities interpreted screening mammography examinations on-site, whereas 91% of facilities interpreted diagnostic examinations on-site. Only three facilities (7%) interpreted screening examinations on line as they were performed. Approximately half of facilities reported using some type of double interpretation, although the methods of double interpretation and the fraction of cases double-interpreted varied widely across facilities. On average, approximately 15% of screening examinations and 10% of diagnostic examinations were reported as being double-interpreted.

Conclusion: Comparison of this survey's results with those collected a decade earlier indicates dramatic changes in the practice of mammography, including a clear distinction between screening and diagnostic mammography, batch interpretation of screening mammograms, and improved quality assurance and medical audit tools. Diffusion of new technologies such as CAD and digital mammography was not widespread. The methods of double-interpretation and the fraction of cases double-interpreted varied widely across study sites.

Fig. 1

Graph shows total charges (technical and interpretation charges) for screening mammography (individual points) compared with the Medicare reimbursement rate for screening mammography (solid line).

Fig. 2

Graph shows total charges (technical and interpretation charges) for diagnostic mammography (individual points) compared with Medicare reimbursement rate for diagnostic mammography (solid line).

Fig. 3

Pie chart shows double-interpretation methods for screening mammograms at 23 U.S. facilities. BI-RADS = Breast Imaging Reporting and Data System [18].