Study finds racial disparities in access to new mammography technology



October 12, 2022 — Among the Medicare population from 2005 to 2020, black women had less access to new mammography technologies than white women, even when having their mammograms at the same facility, study of more than 4 million finds claims published in Radiology, a journal of the Radiological Society of North America (RSNA).

Black women are 40% more likely than white women to die from breast cancer, even though the incidence rate of cancer in black and white women is about the same.

Mammography technology used to screen for breast cancer has undergone two major transitions since 2000: first, the transition from film mammography (SFM) to full-field digital mammography (FFDM) and second, the transition to digital breast tomosynthesis ( DBT). Although these advances in early detection mean that more women can survive breast cancer, not all women have equal access to these new technologies.

More sufficient initial Medicare coverage can facilitate access to new breast cancer screening technologies in underserved areas and reduce the duration of racial and regional disparities in breast cancer care. These disparities are transitory and eventually diminish as technology dissipates from affluent areas—with greater private insurance coverage—to underserved communities where public insurance may be more prevalent. However, this process is prolonged by a Medicare reimbursement 1.2 to 1.8 times lower than that of private insurers.

“In an increasingly competitive health care environment, the Centers for Medicare and Medicaid Services (CMS) cannot expect medical providers to ignore these competitive forces and engage in equity efforts. health without considering economic consequences by locating technology and services where reimbursement is low,” said study co-author Eric W. Christensen, Ph.D., senior researcher in health economics. Health for the Harvey L. Neiman Health Policy Institute and Adjunct Professor of Health Services Management at the University of Minnesota at Minneapolis. “Inequality arises when lower payments make technology investments economically unsustainable for practices that serve higher proportions of Medicare patients.”

The study was the work of the Neiman Health Policy Institute in collaboration with the Radiology Health Equity Coalition (RHEC), an initiative of 10 leading radiology organizations to positively impact health care equity.

“The Radiology Health Equity Coalition understands the indispensable role research plays in addressing health disparities,” said study co-author Jinel Scott, MD, MBA, associate professor of clinical radiology at State University of New York Downstate Health Sciences University Department of Radiology. , and Director of Quality at New York Health and Hospitals/Kings County, New York. “Our paper is an example of the coalition’s goal of moving from primarily descriptive analyzes to predictive and ultimately prescriptive approaches to addressing patient outcomes related to inequities in healthcare delivery.” A Managing Director of the RSNA Board of Trustees, Dr. Scott is RSNA’s representative to RHEC.

For the study, Dr. Christensen, Dr. Scott and their colleagues set out to examine the relationship between race and the use of new mammography technologies among women receiving mammography services.

Researchers conducted a retrospective study of women aged 40 to 89 with fee-for-service health insurance who had mammograms between January 2005 and December 2020, using a 5% sample of all beneficiaries Medicare fee-for-service.

The researchers analyzed 4,028,696 requests for institutional mammography for women (average age 72). Within one facility, the odds ratio (OR) of black women receiving digital mammography rather than FMS in 2005 was 0.80 compared to white women. These differences persisted through 2009. Compared to white women, DBT use within an institution was less likely for black women from 2015 to 2020 (OR: 0.84).

Between facilities, there were racial differences in digital mammography use, which peaked at 3.8 percentage points lower for black women compared to white women in 2011 and then declined to 1.2 percentage point lower in 2016. These results show the transient nature of these differences, and while the transition to DBT is still underway, these differences also appear to be fading.

The study found evidence of racial differences in the years following the introduction of new mammography technology. These disparities include both within-school differences and peer-to-peer differences. According to Dr. Christensen, advocacy for favorable reimbursement policies and incentives can reduce these differences if kept pace with changing technologies.

“Current reimbursement contributes to inequity because locating new technologies in facilities that serve patients with public insurance, Medicare and Medicaid, is not economically viable,” he said. “CMS can create economic incentives to reduce disparities through reimbursement that is either comparable to that of private payers or that more directly incentivizes the adoption of newer technologies in underserved communities.”

The researchers state that organizations have a responsibility to be equitable in the delivery of care. Their ability to do so will be enhanced by refund policies that make it easier to invest in sites that serve the disadvantaged. The fact that racial differences for digital mammography have been transitory and have diminished as the new technology has become universal confirms the real potential of such policy changes to lessen the transitory disparities associated with technological advancements. The equitable provision of breast cancer screening has the potential to improve population health, and support for health policy can propel the US health care system closer to this goal.

RHEC includes RSNA, ACR, American Board of Radiology, American Medical Association Section Council on Radiology, Association of University Radiologists, National Medical Association Section on Radiology and Radiation Oncology, Society of Chairs of Academic Radiology Departments, Society of Interventional Radiologists, Society of Nuclear Medicine and Molecular Imaging, and American Association of Physicists in Medicine. Several other groups, including specialty and state radiology organizations, have also joined the initiative as Coalition partners.

“RSNA supports the work of RHEC and values ​​a cross-society approach that provides members with the information and tools to advocate for the communities they serve,” said Dr. Scott.

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