Medicine Should Not Have a Buyer Beware Clause

There are preventive tests that we should all do regularly, and for women that includes the annual Mammogram. This simple, but albeit, uncomfortable test is very effective in finding breast cancer which can lead to early treatment. Additionally, it falls under Preventive Care, thus it is paid for at 100% by insurance companies. Seems relatively simple, but there are a few landmines that can catch women unawares, turning a no-cost procedure into one that will result in a bill.

The first landmine is when you enter the room. The technician will ask the women if she has any problems with her breasts. If the women answers in the affirmative, regardless of the issue (sore from an ill-fitting bra, soreness from exercise, etc.), that test has suddenly become a Diagnostic Test, no longer covered at 100% and it now needs a diagnosis of a problem from a doctor. I lost count of how many times a lab would contact our office asking for a diagnosis to do a Diagnostic Mammogram, instead of a Screening/Preventive test. We would tell the lab that there was not a problem, we ordered a Screening Mammogram and please do what was ordered. Meanwhile, the patient is worried that there is something wrong and the patient needs to reschedule, thus delaying the test. 

The second landmine is the new 3D Mammograms. These have been available for several years, but incur a cost to the patient. While in the past, it was a passing question to the patient when the test was scheduled, it has now become a worrisome impediment to a vitally important screening test. 

“When Dr. Worta McCaskill-Stevens made an appointment for a mammogram last year, she expected a simple breast cancer screening―not a heavy-handed sales pitch.

A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis.

“She said there’s a new approach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who declined the offer.

A short time later, a technician asked again: Was the patient sure she didn’t want 3D?

Upselling customers on high-tech breast cancer screenings is just one way the 3D mammography industry aggressively promotes its product.”

A Kaiser Health News investigation found that there is a strong marketing push to the general public that the 3D Mammogram is better. These tactics include manufacturers paying influential doctors for their endorsement, there is marketing directly to consumers, manufacturers have lobbied state lawmakers to have insurers cover 3D Mammograms, and the funding of experts and advocates for positive reviews.

“Taxpayers write the check for many 3D screenings, which add about $50 to the cost of a typical mammogram. Medicare, which began paying for 3D exams in 2015, spent an additional $230 million on breast cancer screenings within the first three years of coverage. By 2017, nearly half the mammograms paid for by the federal program were 3D, according to a KHN analysis of federal data.”

Thus for all the hype, 3D Mammograms have not shown to be better at diagnosing Breast Cancer over the conventional digital 2D scan. Unfortunately, where there is money to be made, it seems the facts be damned. In the end, the only loser is the American Patient, by having additional costs added to their already expensive healthcare.