HMSA expanding
breast cancer testingThe decision means members can
make use of computer-aided technology
In a reversal of its position last month, the Hawaii Medical Service Association began covering computer-aided detection of breast cancer.
HMSA's refusal to pay for CAD images as a backup to mammography had been a major issue among radiologists, officials concerned with women's health and the Hawaii Breast Society.
Led by Hilo radiologist Scott Grosskreutz, advocates campaigned to convince HMSA that computer-assisted technology can help save women's lives.
HMSA Vice President Cliff Cisco said after a lot of discussion by the association's committees and doctors and more research with mainland sources, "ultimately we came to the conclusion we will provide benefits for CAD."
He said HMSA is working with physicians on the reimbursement level. "How many machines we need in the state is one of the issues," Cisco added. "A lot of dialogue is going on."
Queen's Breast Health Center, Kapiolani Medical Center for Women & Children, Kuakini Medical Center and Hawaii Radiologic Associates in Hilo are using the R2 ImageChecker, a CAD system approved by the FDA.
"We appreciate the fact that all payers in Hawaii have now decided to match Medicare and reimburse CAD," said Grosskreutz, director of Hawaii Radiologic Associates' Women's Imaging Center.
"We remain concerned that the global levels of reimbursement for both CAD and mammography services are so low in Hawaii that many mammography centers may not be able to afford the new equipment."
Computer-assisted diagnosis provides a second reading to film of a breast examined in mammograms. Films are scanned into a device similar to putting paper into a fax machine. It digitizes and analyzes the mammograms within minutes, using a computer algorithm to flag trouble spots.
Studies show it can improve detection of breast cancer by 20 percent to 23 percent, said Grosskreutz.
He said an estimated 48 million American women have insurance plans that reimburse CAD as a "second eye" with mammography for signs of cancer.
Dr. William Osheroff, head of HMSA's Office of Medical Directors, said there is some data that computer-assisted detection will find some cancers early. "It doesn't find all cancers missed by radiologists but it does find those associated with calcium."
He emphasized, however, "If we're going to reduce the breast cancer mortality rate, we have to get all women to get mammograms to start with. I think right now that is the biggest opportunity to have a significant impact."
Kaiser Permanente spokeswoman Jan Kagehiro said Kaiser covers mammography and CAD images at Hawaii Radiologic Associates for Hilo and Kona patients because mammography services aren't available at Kaiser's Big Island facilities. Radiologists and breast health team members at Kaiser's Moanalua Medical Center are looking into a CAD system, she said.
Michelle Meredith, manager of Kapiolani's Women's Center, said 85 percent of women with HMSA plans going there for breast screening were paying $30 out of pocket for computer-assisted readings.
"Even though their insurance carrier is not paying for it, they're saying, 'It's important enough to me, I want this done,' " she said before HMSA's decision to cover the service.
Kapiolani's doctors say the new technology "is a tremendous help," Meredith said. "They are able to detect areas of concern more easily." An increased cancer detection rate of at least 20 percent "is huge," she said.
Dr. John Soong, Queen's radiologist, said CAD is "like 'Hamburger Helper.' It's a mammography helper ... Even if it increases (detection) by 5 percent, it's beneficial, and as it turns out it's double-digit."
Double-reading of mammograms by radiologists is considered slightly better than computer-aided technology for early detection of breast lesions, Soong said. But there aren't enough radiologists to do double readings outside of academic settings because of a nationwide shortage of radiologists, he said.
