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Mammogram data show trouble

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By Dave Gulliver
7/8/2010 © Health News Florida 

Most Florida hospital outpatient departments are performing either too many mammograms, exposing patients to unnecessary risks, or too few, and missing signs of cancer.

The findings come in data released Wednesday on the federal Hospital Compare website. The site also shows which hospital outpatient departments are running too many CT-scans (article on CT scans coming Friday).

While the site has reported for years on other conditions, such as hospitals’ heart attack mortality or pneumonia readmissions, the new data contain the first look at the booming field of diagnostic imaging.

Imaging has been one of the most profitable and fastest-growing fields in health care, prompting the Center for Medicare and Medicaid Services to begin cutting what it pays for the scans.

The reports examine how frequently hospital outpatient centers perform four common tests: MRI scans for lower back pain; mammograms, used to detect breast cancer, and CT scans of the chest and abdomen. Two measures have been endorsed by the National Quality Forum, a healthcare standards group, while two others are under discussion.

“We hope these four new measures will shine a spotlight on imaging, and discourage overuse,” said Dr. Barry M. Straube, chief medical officer at the Center for Medicare and Medicaid Services, which produces Hospital Compare.

While the website is aimed at consumers, the data have an added significance: In 2013, they will be the backbone of a CMS program that will set the prices the agency pays doctors and hospitals.

Straube said the imaging report is still a “work in progress,” and for three of the measures, the agency declined to set a threshold for what was too much or too little use of a procedure.

But the agency did provide guidance on the issue of multiple mammograms in a short period.

The Hospital Compare study examined how often patients having a mammogram screening study also have a follow-up outpatient mammogram or ultrasound within 45 days, referred to as a callback or recall.

CMS suggests that hospitals with recall rates greater than 14 percent are unusually high, and may be performing unnecessary followups. Hospitals recalling less than 8 percent may not be doing enough follow-up and may be missing signs of cancer, the agency said. See chart with list of hospitals. 

In Florida, 137 hospitals reported enough cases for CMS to analyze. Of them, 70 fell either above or below the CMS guidelines.

Most were on the low end, with 43 hospitals falling below the 8 percent threshold. Aventura Hospital and Medical Center, in Miami-Dade, recalled only 1.6 percent of mammogram patients.

Another 27 exceeded the upper 14 percent threshold CMS cited. Columbia Hospital in Palm Beach recalled more than 40 percent of mammogram patients, CMS found.

Most hospital officials contacted by Health News Florida declined to comment on the results, saying they had not had time to look at the figures.

But Dr. Keyser Enneking, chair of the quality committee at University of Florida’s Shands HealthCare System, said the data -- though old, possibly inaccurate and lacking in context -- serve an important purpose. Mammograms are a good example, she said.

“I agree with the recommendation that people don’t need as many mammograms as they get,” she said. “I’m not sure it’s promoting health, in the grand scheme of things.”

Two issues drive the high numbers of the test, she said. Frequently, the initial scan is too poor for a clear diagnosis. And that means health care organizations need to do better.

“Medicine got very complacent,” she said. “As we got better technology and better outcomes, we didn’t change our processes to make them more patient-oriented.”

--Dave Gulliver is an independent journalist in Sarasota.