Mammography cutbacks
creating health care ‘crisis’
A Hawaii breast cancer awareness organization is warning that reduced access to mammography services could hamper disease detection in the state, which already has a high incidence of breast cancer.
Inadequate government and private insurance payments for mammography services, aging screening equipment, a shortage of mammography technicians and radiologists, and the closure of money-losing radiology clinics are among the problems, the Hawaii Breast Society says.
"The impending mammography crisis in Hawaii is currently unseen but particularly acute," said Dr. Scott Grosskreutz, director of the Hawaii Radiologic Associates' Women's Imaging Center and founder of the Hawaii Breast Society.
Hawaii has the highest incidence of breast cancer among Caucasian women in the nation, and native Hawaiians have the highest incidence and death rate from the disease, the society points out.
Mammograms are considered the best means of detecting breast cancer and preventing deaths.
Mammography services are jeopardized by Medicare, Medicaid and private insurance payments that do not cover costs, Grosskreutz said.
"This is particularly true because the cost of operating mammography centers is substantially higher in Hawaii than on the mainland," he said.
Dr. Jon Shanser, of the American College of Radiology, said in a briefing to the Hawaii Radiology Society last month that nearly 1,000 mammography clinics closed nationwide in the past few years.
Hawaii had 43 clinics in 2001 and 41 last year.
"We fully expect many more to be forced to close in the next two or three years," Grosskreutz said.
Many clinics cannot afford to modernize aging equipment, he said, noting one-third of Hawaii's mammography units are more than 5 years old and another third are more than 10 years old.
Women, particularly in underserved areas, will have less access to mammography as clinics close, Grosskreutz said.
Hawaii Medical Association President Sherrel Hammar said, "To deprive women of the full scope of mammography with new equipment in the long run is going to be deleterious."
He said all women should be encouraged to get regular breast screening, but it discourages them if they have to pay any part of the cost.
The association, with its political action group and lobbying effort, will try to make some changes, Hammar said.
The state House of Representatives passed a resolution outlining mammography access problems and asking the state Department of Health, Hawaii Medical Association and American Cancer Society to support reimbursements that would cover the cost of breast imaging services and updated equipment.
"Our technology is not up to date," said House Health Committee Chairman Dennis Arakaki (D, Kamehameha Heights-Kalihi Valley). "We're not getting good results from mammography exams, and it also costs more to utilize older equipment."
The Legislature mandated last year that each health policy provide coverage for mammography screening, Arakaki said. "We need to ensure they're (clinics) getting reimbursed at cost, if nothing else."
Grosskreutz said: "To make matters worst, HMSA has just announced a statewide cost campaign to reduce the availability of imaging services and further reduce reimbursements. ... Further decreases will seriously damage the health care delivery system for women in Hawaii."
HMSA Vice President Cliff Cisco said the association is conducting a "cost educational campaign" but has no plan to reduce imaging services.
He said HMSA constantly adjusts fees up and down. "We're very concerned. A lot of pressure is being placed on us to address the issue of rising health care costs.
"One of the significant costs pushing up inflation is radiology," Cisco said. "More and more radiology services are being used every year, with more and more technology at higher levels."
In a letter to the Hawaii Medical Association last fall, Dr. Eugene Wasson III, then Hawaii Radiological Society president, said any closing of a mammography facility in Hawaii makes access more difficult at remaining sites.
He said the "unfortunate trend" of closures primarily relates to low reimbursements but is compounded by a shortage of mammography technologists and radiologists.
"It is mandatory that we do whatever is possible to facilitate prompt and proper breast diagnosis, and certainly adequate compensation is critical," Wasson said. "It is not feasible for facilities to continually lose money and still be willing to provide that service."
Stan Berry, chief executive officer of North Hawaii Community Hospital, said hospitals are concerned about breast cancer and providing greater access to imaging services.