How are supply-side factors associated with county-level screening mammography rates?

Supply-side factors such as the number of mammography facilities and the number of breast imaging specialists are weakly associated with county-level Medicare beneficiary screening mammography rates, according to a new study published in Academic Radiology.

Overall, the authors studied more than 3,000 U.S. counties and found an average Medicare fee-for-service (FFS) beneficiary screening mammography rate of 60.5 percent. The range was from 26 percent to 88 percent.

A “weak, yet statistically significant, positive correlation” was found between a county’s Medicare beneficiary screening mammography rate and the total number of mammography facilities per 100,000 square miles. In addition, the correlation between county-level screening mammography rates and total breast imaging subspecialist radiologists per 100,00 Medicare beneficiaries was found to be “minimal.”

The authors explained that these weak and minimal associations make screening mammography rates different from other healthcare services such as “prenatal care, chemotherapy and radiation.” For those services, supply-side factors were found to have a stronger association with utilization rates.

“Our findings suggest that while expanding the supply of mammography facilities and trained radiologists could improve screening mammography compliance, efforts focusing on demand-side factors may be more effective,” wrote lead author Andrew B. Rosenkrantz, MD, MPA, of the department of radiology at NYU Langone Medical Center in New York City, and colleagues. “That is, rather than taking an exclusive supply-oriented approach of simply building more centers or training and hiring more radiologists, radiology practices may be more impactful focusing on initiatives that involve direct patient outreach and education, behavioral interventions, dissemination of guidelines, leveraging informatics-based solutions such as automated reminders and patient tracking systems, and developing of relationships with referring primary care physicians who counsel patients to undergo screening.”

The authors added that “insurance coverage and insurance coverage shortfalls” could also play a factor in improving screening mammography rates.