Department of Health, Minutes from Mammography Accessibility Workgroup Excerpts from the minutes (August 5, 2004)
Ms. Betsey Herd drew attention to the breakout of cost and utilization. She asked about the area of cost to see if they would seek out what will reveal the utilization rates. Mr. Hefren stated that cost is how much the customer pays, which depends on the type of insurance. They are going to capture that, and for the uninsured they can probably go down to the facility level. Private insurers would have to give their costs for private insurance co-pay and amounts listed. Mr. Hefren asked if that answered Ms. Herd's question.
Ms. Herd asked if he would be able to gather what doctors are being reimbursed for the mammogram itself. Mr. Hefren replied that they would be able to gather how much a facility receives for the service. He is unsure whether they can capture how much the physician receives.
Ms. Herd asked, if in the case of someone who was uninsured, could they find out what companies are reimbursing for the study of radiologic work and the rates.
Ms. Betsey Herd asked about the map listing the Florida facilities. She wanted to know if it refers to certified facilities, and if reimbursement is tied with state and federal Medicaid/Medicare. Ms. Blake responded that the facilities must be certified to offer mammography.
Ms. Betsey Herd asked where breast ultrasound fits in and whether is it appropriate. Dr. Swain stated that within their practice, every woman who has a palpable abnormality gets an ultrasound. It is also used for abnormal mammograms. Some facilities do screening ultrasounds, but they do not. Ms. Betsey Herd stated that experts (in this case the radiologists) dictate the standard of care and testify to this in court. Dr. Swain questioned the definition of expert and noted that they don't always speak the truth. The workgroup members discussed how sometimes it happens that it is not thought that a mammogram shows a problem, but then two or three years later something does develop and upon returning to the mammogram, you see where maybe something should have been detected. Ms. Cynthia Simmons Fletcher stated that hindsight bias is not necessarily factored in to what the expert sees two years later.
Ms. Betsey Herd asked if the workgroup could get the US General Accounting Office mammography studies from 2002 and 2003. Ms. Eaton agreed. Dr. Romilly indicated that in terms of facilities and number of machines, the MQSA certifies facilities, and the number of machines is certified through the American College and that information can be obtained from them.
