Apr06 eBroadcast - The Story of The Women's Center for Radiology

The DMIST strategy

Faced with less-than-impressive reimbursement rates for breast cancer screening, the team's pioneering attitude is extending to the development of new strategies there, too. Dr. Belfer wanted to use established, widely-accepted criteria on which to base this approach, so he chose the results of the Digital Mammography Imaging Screening Trial (DMIST) recommendations. While DMIST screening criteria could be used to justify reimbursement for digital exams for a certain portion of URP's patients - most notably women under 50, women with dense breasts and premenopausal or perimenopausal women -- accurately categorizing the needs of URP's entire 40,000 patient population was extremely complicated and untenable on a day-to-day basis. "We checked our database to see how many of those patients would benefit from a digital exam according to DMIST criteria. I proposed to have one price for the insurance payers: a combination of the price between digital and analog multiplied by the incidence of the patients who will benefit." This creative solution will lower the cost for the payers and raise the reimbursement rate for URP. Even before applying this idea, some of the payers called asking how much we would charge to perform digital on all of their patients. That means that some of the payers are capable of foreseeing the digital advantage in a mammography center.