April 10, 2019

TMIST Payment for Uninsured Women Draws Interest at SBI Meeting

Pisano Explains TMIST Opportunities at SBI Meeting

Tomosynthesis Mammographic Imaging Screening Trial (TMIST) principal investigator Etta Pisano, MD, spoke to a packed room at the 2019 Society of Breast Imaging/American College of Radiology Breast Imaging Symposium.

Dozens of radiologists showed up to find out how they and their practices can take part in the first large randomized, controlled trial (RCT) that seeks to identify any groups of women in which tomosynthesis may outperform digital mammography at reducing advanced breast cancer development.

Interest is growing in the NIH sponsored trial — particularly among radiologists that may serve many uninsured women. TMIST is one of a comparatively few large clinical trials that offers provider reimbursement for women who qualify for charity care at a site.

Overall, for the initial exam for each woman enrolled (insured or uninsured), sites receive $500. If the woman is insured, they also receive the usual payment from the insurer. If the woman is uninsured and qualifies for charity care at the site, sites receive an additional $138.17 from TMIST for this initial exam.

For each follow-up screening for insured women, TMIST pays sites $150 on top of the insurance payment. For each follow-up exam for uninsured women who qualify for charity care at the site, TMIST pays sites $150 plus an additional $138.17.

This possible total $288.17 TMIST payment ($150 + $138.17) for each follow-up exam for uninsured patients may be triple that paid to providers for such services by major breast cancer care charitable organizations.

A recently approved $30,000 reimbursement advance can help select facilities immediately hire a research assistant as an on-site coordinator and avoid added responsibilities to existing staff. This can be particularly impactful for sites in underserved areas — including small and rural practice providers.

The study provides additional payment to sites for submission of biopsy, blood and buccal smear samples that patients are asked to provide. These submissions will create the world’s largest breast cancer screening biorepository to help tailor future, risk-based screening policy.

Approximately 70 sites are now open and accruing patients. The trial will add at least 70 more sites and enroll 165,000 healthy women, ages 45 to 74, who are already planning to get routine mammograms.

As a great many — perhaps more than 20 — papers may ultimately be produced from TMIST data, site investigators will have a great opportunity to author or coauthor publications in major medical journals.

Given the large trial size (165,000 patients), TMIST dwarfs most treatment or industry-sponsored studies and allows for significant reimbursement that more than pays for resources needed for trial participation.

TMIST is necessary to inform tomosynthesis clinical and payment updates. Decision makers rarely update clinical or payment policy without such a large RCT in the evidence base.

Visit acr.org/TMIST to get more information on how your practice can become a TMIST site.

Email TMIST@acr.org with any questions you may have about TMIST.