Will breast biopsy reimbursement cuts lead to more surgical procedures?

Women's imaging advocates are predicting that open surgical biopsies could become more common if Medicare reimbursement cuts for stereotactic biopsy procedures are implemented this year. According to an article in AuntMinnie.com, the feeling among women's imaging advocates is that the proposed cuts could be drastic enough to force health providers to stop providing stereotactic biopsy services.

In an article in the January issue of the Journal of the American College of Radiology, Ezequiel Silva III, M.D., of the University of Texas Health Center reported that the cuts will result in an average 24 percent reduction to the professional component, and a 17 percent reduction to the technical component across the breast intervention code family.

Silva also wrote that the Centers for Medicare & Medicaid Services will be paying hospitals 50 percent less for the procedures under the Hospital Oupatient Prospective Payment System (HOPPS). That, he told AuntMinnie.com, could lead to a decline in the availability of such services, as they may no longer be economically feasible for certain kinds of hospitals, such as those found in inner cities and in rural communities.

Consequently, if stereotactic breast biopsy is no longer an option for some healthcare providers, it could mean a comeback for surgical biopsy, according to Mark Gittleman, M.D., of the American Society of Breast Surgeons Coding and Reimbursement Advisory Group.

"Most stereotactic biopsies are performed by radiologists in facility settings, and if they aren't going to be reimbursed for the cost of the procedure, my fear is that these physicians will decide they can't afford to do them, and there will be a return to open excisional biopsies--to the detriment of both patients and payers," Gittleman told AuntMinnie.com.

Silva, in an interview with DOTmed News, called on Congress to reverse the 2014 reductions and fix reimbursements at the 2013 rates. He also said that breast imaging advocates should be putting pressure on Congress, as well.

"I'm hopeful that the breast advocacy community will be very mindful and very watchful for decreases in access to care because at that point when we see centers closing and we see patients struggling to receive these services, I think that is the point where the breast advocacy community would take action," Silva said.

To learn more:
- see the JACR article
- read the article in AuntMinnie.com
- see the article in DOTmed News

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