Survey Finds Women Unwilling to Pay for Immediate Mammography Results

Would you pay an additional fee to get your screeningmammography results right after your examination? In a random survey of 120women, the majority said no. In fact, one-third of the women said they preferredto get their results at a later time. The survey results were published in theSeptember 2001 issue of the American Journal of Roentgenology.

"We conducted the study to determine whether patients really wanted toget their screening mammography results immediately, what the cost would be toour facility to provide immediate reporting, and if patients would bewilling to pay at least part of those costs," said Sughra Raza, MD, thelead author of the investigation.

"We were surprised that only 67% of the women indicated they preferredimmediate reporting," said Dr. Raza. "We expected this number to bemuch higher because we are hearing from our patients and our referringphysicians that they want to know the results right away." A benefit toimmediate reporting is that if something is found on a screening mammogram,additional tests can be performed immediately. In addition, the patient does nothave to wait to get her results, so she may feel less anxious about theexamination. "Despite what we’re hearing and the added convenience, therewas still a substantial number of women who are willing to wait for theirresults," said Dr. Raza.

Effects of Cost and Reimbursement

Immediate reporting can cost a facility between $4 and $29. "We foundthat if a facility is working at capacity and would need to add staff time,equipment, and a room to allow the physician to talk to the patient about themammogram results, the cost for immediate reporting would be $28.22 perpatient," said Dr. Raza. On the other hand, if no additional space orequipment was needed then the cost would be $4.38 per patient. These figures arebased on costs at Beth Israel Deaconess Medical Center in Boston, where thestudy was conducted. "Costs will vary from place to place," said Dr.Raza, who is now associate director of breast imaging at Brigham and Women’sHospital in Boston.

"Our survey found that the majority of our respondents don’t want tohelp bear these costs," she said. Among patients who said they preferredimmediate reporting, 60% said they would not be willing to pay an additionalfee; 24% said they would pay an additional $10, and 11% said they would pay anadditional $25.

The cost factor is only one of the difficulties of immediate reporting, notedDr. Raza. Reimbursement is another problem. For example, while some insurancepolicies will reimburse a sonogram performed on the same day as the screeningmammogram, many policies will not pay for the sonogram if an ultrasound-guidedprocedure is also performed. In the latter case, only the procedure isreimbursed. This means that if something is found on the mammogram, anultrasound can be performed but may not be fully paid for by insurance or,alternatively, the patient has to come back for the ultrasound in order forinsurance to pay for it. In addition to these two issues, "immediatereporting puts pressure on the radiologist to read mammograms rapidly andaccurately, with repeated interruptions," said Dr. Raza.

Interpretation Requires Concentration

"My preference is still toward batch reading, where the radiologistreads a number of mammograms in one sitting. This allows for the kind ofconcentration necessary for mammography interpretation," she said."There are multiple other health screening tests where the patient has towait for results, and people are used to that. Unfortunately, there is ahysteria surrounding breast cancer. We need to reassure women that 90% to 95% ofthe time they won’t need to have additional tests done, and that a laterreport—whether negative or positive—isn’t going to make any differenceclinically."