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Re: Office MammographyFrom: Scotia Phillips, RT, RDMS (scotia@bellsouth.net)Wed Mar 31 06:01:44 1999
At Mon, 29 Mar 1999, Hugo D. Ribot Jr. wrote: > >Dear Private Practitioners on the hallowed List: > I am not a physician, but I am qualified to answer your valid questions by virtue of the fact that I have managed a private Imaging Center (once physican owned, now corporate owned) for 16 years. We perform Mammography, Sonography and Osteoporosis testing (DEXA at this time).
>My associate and I are desperately in search of real life experience by In Alabama, this is not necessary. The scattered radiation from present mammography units is not significant outside a reasonable sized room. I would suggest at least 10' by 12'. Contact your state Bureau of Radiologic Health to see if this is required, or obtain the services of a consultant, preferrably a Radiation Health Physicist who is licensed for mammography. You will need him or her later anyway.
>2) ACR certification
>3) liability
Well, you gotta figure that one for yourself. There is a tremendous
amount of documentation associated with mammos that if performed
meticulously, will help a great deal, but evryone is liable in this
litiginous society.
> Alabama BC/BS pays $64 for Global Screening Mammography CPT code 76092 Medicare allows about $62 Medicaid $46!!!
>
This is the most important reason for providing this service, and it is
a service that is greatly appreciated by patients. The convenience,
especially for today's busy/working woman makes a big difference in your
GYN practice in the long run. You are NOT going to make any money on
mammos! But, you may find more patients than you want due to the
convenience that you will offer.
> I would not recommend this practice. According to the regs, if you take self-referred patients, you must have a mechanism in place for referral of patients with abnormal results to the proper place. Many of these patients will not be insured, non-compliant, etc. We only take patients who are referred to us from a health practitioner. You may find other Docs not in your practice like the convenience you can offer.
Also, most self-referred patients have what they think is a problem, but
for whatever reason, don't want to see a doctor. "A NEGATIVE MAMMOGRAM
SHOULD NOT EXCLUDE BIOSPY IN A PATIENT WITH A PALPABLE MASS". You have
seen this disclaimer, it's there for a reason. What if a patient has a
clinically significant mass that is undetected by mammo and she assumes
that her negative mammo means she does NOT have cancer? It happens! Here
is where your liablity is a problem.
> Did you say 480 mammos a year? Is that just yours or the total for your practice? Here's an estimate for your costs. You do the math! Machine $70,000 (Good for at least 5 years if you buy wisely) Processor $10,000 Casettes, phantom, misc. start-up needs $7,000 ACR Fees $800 Physicist Fees $1000 FDA Inspection Fees $1700 Radiologist Fees (you gotta have one, you don't qualify to read mammos) This depends on your local and arrangements. Expect to spend about $20 per patient. Film/ Chemistry Cost: $6 per patient Mammographer: I'm paid for mammos as well as other procedures and management. My mammographer, who is experienced, makes $13/hour plus benefits. There is a great need for registered Mammographers in my area, they make a premium wage. I am fortunate to have this one. She has small children and I let her pick her hours and cover for her when she can't work. You cannot do mammos if you don't have a registered Mammographer. All your costs will increase if you fail any part of the accreditation/certification process. Do not listen to equipment sales folks that tell 3 a day will pay for the equipment. I have only touched on the complications associated with mammos. If you need any further info, contact me.
We do 3000 mammos a year, as well as breast sonography when indicated.
Our breast work breaks even financially. Just barely at this high
volume. It is, of course a wonderful service. Good luck if you decide
to offer it!
>
-- Scot
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