HCFA's Proposed Changes: Impact on Women's Health

The proposed reimbursement for breast biopsy will not cover the costs of advanced stereotactic technology introduced after the 1994 survey. As a result, Medicare beneficiaries with suspicious mammograms will have restricted access to new minimally invasive surgical technologies in an ASC. If the proposed ruling is enacted on 10/1/98, Medicare will create a perverse incentive for physicians to send their aging patients to the hospital for ambulatory procedures because this approach will be better reimbursed than a minimally invasive approach in a less intensive setting.

Up until 1994, a common approach to breast biopsy in an ASC was a core needle biopsy. In late 1994, advancements in breast biopsy technology began to appear. Currently, an ASC receives $422 for an incisional and $482 for an excisional biopsy. This proposal seeks to combine incisional and excisional into one payment group, with reduced reimbursement = $411 (Table #1).

 

 

If enacted, aging women will be denied access to advancements in breast diagnostics in an ASC.
Women will encounter a similar financial obstacle when trying to access new advancements in endometrial ablation technologies, where the proposed reimbursement ($610) will not cover the cost of new technology introduced since 1994 (Table #2).

In contrast, two new minimally invasive surgical procedures appear on HCFA's proposed services list for treating benign prostatic hypertrophy (BPH) in men with a proposed increase in reimbursement that will equally accommodate all three surgical approaches @ $1,131 (Table #2).

 

Find out what you can do to get revisions made to this proposal before it is approved