Scott Grosskreutz, MD, diagnostic radiologist and president, Hawaii Radiological Society, contributed this post.

Hawaii’s small size and geographic isolation are part of the state’s charm, but these factors can contribute to slower adoption of newer technology such as digital breast tomosynthesis (DBT). In 2018, less than half of women in Hawaii were covered for DBT —the lowest rate of all 50 states. Our radiologists want to be able to provide the most accurate examination for all our patients, and DBT has been shown to improve breast cancer detection and decrease recall rates.

The Hawaii Radiological Society (HRS) introduced a bill into the state legislature last session, which would have mandated insurance coverage of tomosynthesis. Dr. Kelly Biggs, chair of the American College of Radiology® (ACR®) Breast Imaging Commission’s Government Relations subcommittee, provided supporting material, and Dr. Dana Smetherman, chair of the ACR Breast Imaging Commission, published a commentary with HRS president Dr. Elizabeth Ignacio in Hawaii’s largest newspaper advocating tomosynthesis.

With testimony from dozens of radiologists, patients and referring providers, the bill sailed through the House and Senate chambers on the first three readings without a single no vote, but was effectively tabled when the Conference Committee declined to convene.

We immediately met with legislators who agreed to reintroduce the bill during the next session and reached out to medical directors of third party payers in Hawaii. Together, we established insurance coverage and convinced the state workers’ trust fund board to provide full DBT coverage – meaning that women in Hawaii will soon have 100% coverage for DBT. This universal coverage relieves mammography staff from the fiscal necessity of requesting copays from uninsured patients, enabling them to focus on patient care and productivity.

From our experience we offer the following suggestions:

  1. Achieving coverage for DBT is a team effort. The ACR provides great resources and support, including access to experts who can help you develop your strategy for achieving coverage.
  2. Share your local DBT experience. Straub Hospital in Honolulu provided a study of two-dimensional (2D) vs three-dimensional (3D) mammography. They found that DBT had almost double the cancer detection rate compared with 2D. What’s more, a large percent of women in Hawaii are of Asian ancestry, who tend to have the densest breast tissue of any ethnic group. It’s important that this demographic-specific information about the benefits of DBT in assessing women with dense breast was shared through our advocacy efforts.
  3. If at first you don’t succeed, don’t give up! By immediately arranging sponsors for the bill’s reintroduction, we ensured public attention remained on the issue.
  4. The medical directors working for insurance companies are our physician colleagues and share our concern for our patients. Their organizations focus on cost effectiveness and cost containment. We need to respect their concerns and be responsive to their questions. Developing a good working relationship ensures that your advocacy effort will have a fair hearing when future issues arise.

Nationally, 93% of women ages 40 to 74 have coverage for DBT, according to Truven Health Analytics. It’s time to make DBT 100% covered for all women in the US.

Coverage for tomosynthesis by state in 2018

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