Think about how innovations in health care have transformed our lives. Where would we be without penicillin?
Now think about how new technologies, medicines and procedures appropriately come under review by payers.
Here’s a current example brought to our attention by many of our clients.
A local hospital system is widely advertising the latest technology in breast cancer detection; i.e., 3-D mammography. Although more expensive than a standard mammogram, a strong argument can be made for its use.
Read more at BreastCancer.org.
Most insurers however, claim there is “no clinical evidence that tomosynthesis (3D) mammograms are better.” Therefore, they are not approved for coverage.
Are payers being penny wise and pound foolish?
Until this is resolved, providers might be persuaded to code the procedure as a routine mammogram, so that at least some portion of the cost is covered by insurance.
Note that it was 15 years from when penicillin was discovered (1928) until it became widely used (1943).
We’ll get this right, too. Sooner than later, let’s hope!