DBT coverage mandates increase use but have no impact on patients’ out-of-pocket costs
Digital breast tomosynthesis coverage mandates appear to increase use of the technology but have little impact on out-of-pocket costs, according to research published Friday in JAMA Network Open.
DBT has supplanted standard, two-dimensional mammography as the standard of care during the past decade, given its higher sensitivity and impact on breast cancer screening callbacks. However, without a federal requirement to reimburse for the exam, some private payers have been slow to cover DBT, instead labeling it as elective.
Seventeen states have enacted their own mandates to address this. Yale School of Medicine experts recently set out to examine the impact of such laws, with their analysis unearthing mixed results.
“State-level mandates requiring coverage for screening DBT were associated with meaningful increases in DBT use and relative reductions in DBT price,” Ilana Richman, MD, a professor and general internist with the New Haven, Connecticut institution, and co-authors concluded. “Our findings overall suggest that mandates may encourage DBT use but also may have more complex implications for the associations among technology adoption, price and value.”
Researchers gathered their data from the Blue Cross Blue Shield Axis database, incorporating women ages 40-64 imaged between 2015 to 2019. The study included a total of 9.6 million mammograms received by more than 5.7 million women. Fifteen states adopted DBT coverage mandates during the study period while 34 states did not. Those that did require coverage saw DBT use increase 9 percentage points by two years afterward versus no such gains in other states. Meanwhile, mandates led to a nearly $39 net decrease in the average price of DBT, but no such changes for out-of-pocket payment.
“As DBT use increased in both mandate and nonmandate states, we did not observe an increase in the proportion of women with out-of-pocket payments in nonmandate states compared with mandate states,” Richman and co-authors noted. “These findings suggest that out-of-pocket payments were rare regardless of whether a mandate was in place and likely were not the primary barrier to DBT use for most women. Instead, our findings raise the possibility that DBT coverage mandates contributed to broader adoption of DBT among radiologists, perhaps by reducing uncertainty about payment.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.