On April 8, the Senate Health, Education, Labor and Pensions Committee held a hearing on the reauthorization of the Mammography Quality Standards Act (MQSA), first enacted in 1992. The MQSA sought to correct wide variations in the quality of mammography screening around the country. The bill established uniform equipment, personnel, and quality standards; required mammography facilities to employ qualified physicians to interpret mammogram results; and created a quality assurance and control program.
The hearing focused on two issues: how mammography interpretive self-assessment tests for radiologists should be incorporated into the reauthorization of the MQSA, and the current shortage of radiologists due to low reimbursement and the impact of medical liability.
Self-assessment tests to strengthen mammography interpretive skills have been developed as a way for radiologists to gain experience reading mammograms and to assess their skill level. Many feel that this type of assessment is more effective than the lectures usually offered in Continuing Medical Education (CME) programs. While the three witnesses agreed that self-assessment is beneficial, there was some disagreement as to how self-assessment tests should be incorporated into the MQSA.
Sen. John Ensign (R-NV), acting Committee Chair, opened the hearing by stressing the importance of the MQSA and the serious threat of breast cancer. “Breast cancer is the second main cause of cancer deaths among women,” he noted. “An estimated 211,300 new cases are expected to occur in the United States this year.” Sen. Ensign mentioned the need to protect self-assessment test results from being used in litigation against radiology professionals. “Congress must balance the need to find ways to improve the quality and delivery of women’s health, while at the same time preserving a positive and equitable medical environment for well-intentioned professionals to practice,” he said.
Sen. Barbara Mikulski (D-MD) highlighted the role of the MQSA in women’s health. “By creating national standards,” she said, “Congress helped make mammograms a more reliable tool for detecting breast cancer.” Sen. Mikulski raised her concern that, according to recent reports, mammograms are often misread. She emphasized the need for “the right balance to improve the skills of physicians reading mammograms,” while avoiding “steps that drive radiologists away from mammography.”
Dr. David Dershaw of the Society for Breast Imaging agreed that “the MQSA has played a significant role in improving the quality of mammography,” but noted that “the greatest threat to the delivery of quality mammography services in the United States is the impending shortage of radiologists, technologists, and imaging facilities.” He explained that the shortage is due to poor reimbursement rates for radiologists, costly litigation, and the “time and effort required to meet federal, and often local, regulation.” He said there is an impression of mammography as a “big money loser” and that this “works to discourage those in training from selecting mammography as an area of specialization.”
Dr. Dershaw warned against worsening the shortage of radiologists by adding “an additional regulation of mandated self-evaluation,” which “might further discourage radiologists to incorporate mammography into their careers.” He also stated that “if results of self-assessment activities were to be subjected to discoverability in litigation cases against physicians, the Society of Breast Imaging would strongly oppose the incorporation of such testing in to MQSA regulation.”
Diana Rowden of the Susan G. Komen Breast Cancer Foundation, and a breast cancer survivor, said, “Though MQSA has had a positive impact, we still have a long way to go.” Ms. Rowden stressed the importance of self-assessment as “hands-on” training. “Self-assessment would provide radiologists with real-time feedback about how well they are doing and where improvement is needed,” she said. While not specifically mentioning discoverability of self-assessment results, Ms. Rowden did point out the need for Congress to avoid creating “additional barriers…to quality care.” “In view of the difficult questions that must be addressed,” she added, “the Komen Foundation strongly supports a two-year reauthorization time frame for MQSA.”
Dr. Leonard Berlin of the Rush North Shore Medical Center’s Department of Radiology highlighted “the adverse impact of medical malpractice litigation on the practice of radiology, specifically as it relates to mammography.” He pointed out that the public “misperceives that mammography should be 100% accurate,” not realizing that “perhaps 15% to 20% of breast cancers do not appear on mammograms.” This misperception leads to frequent lawsuits and, combined with low reimbursement, results in radiologists leaving this field of practice. Dr. Berlin advised that Congress deem self-assessment results non-discoverable if mandated self-assessment is enacted.
