The Digital Mammography Debate and Medical Inflation


National Naval Medical Center, Bethesda, Md. (...

Newsweek reported on the emergence of digital mammography in a recent article.  Scathingly titled “The Mammogram Hustle”, it discussed how new digital mammogram (DM) technology challenged film mammograms despite a lack of evidence that it is better at detecting cancers.  The authors describe how digital mammogram manufacturers lobbied Congress to increase the reimbursements for DM in order to entice purchase of the new and more expensive system.  It states that in 2003-08, Medicare paid an additional $350M for DM, with no evidence that this improved cancer detection or lives saved over existing film technology.

The article illustrates two important contributors to increased health spending:

Using anecdotal evidence instead of real science
When Congressman Clay Shaw was shown a digital image compared to film, he was impressed enough to introduce a bill that increased Medicare payment for DM.  A radiologist pitched the digital machine at its launch.  Some patients demanded the digital imaging to make sure they were getting the latest technology.

Wide introduction of new technology before proof of better outcomes
It took several years after the payment change for widespread implementation to take place.  After 2005, DM became more widely implemented in response to an article showing benefit of DM in certain populations of women.

New technology is critical as medicine strives for progress and improvement, and systems that encourage more women to get mammography screening are positive.  It is impractical for most facilities to have both types of imaging systems.  There are many good reasons to change to digital imaging, and there may have been ways to encourage facilities to implement DM without committing Medicare to overpay for the same net benefit.

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