[Congressional Record Volume 147, Number 35 (Thursday, March 15, 2001)]
[Senate]
[Pages S2398-S2402]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Ms. Snowe, Ms. Mikulski, Mr. 
        Murkowski, Mrs. Murray, Mr. Schumer, and Mr. Reid):
  S. 548. A bill to amend title XVIII of the Social Security Act to 
provide enhanced reimbursement for, and expanded capacity to, 
mammography services under the medicare program, and for other 
purposes; to the Committee on finance.
  Mr. HARKIN. Mr. President, I am pleased to be joined today by 
Senators Snowe, Mikulski, Murkowski, Murray, Schumer and Reid to 
introduce the ``Assure Access to Mammography Act of 2001.'' This 
important legislation will help improve access to life-saving breast 
screenings for millions of women.
  I lost both of my sisters to breast cancer. I strongly believe that 
if they had had access to regular mammography services and today's 
advanced treatments, they would still be alive today.
  Over the past several years, we've made a great deal of progress 
against breast cancer. In particular, we've been able to secure 
significant funding increases for research to understand the causes of 
and find treatments for breast cancer.
  Almost a decade ago, when I looked into the issue of breast cancer 
research, I discovered that barely $90 million was spent on breast 
cancer research.
  That's why, in 1992, I offered an amendment to dedicate $210 million 
in the Defense Department Budget for breast cancer research. This 
funding was in addition to the funding for breast cancer research 
conducted at the National Institutes of Health. My amendment passed 
and, overnight, it doubled Federal funding for breast cancer.
  Since then, funding for breast cancer research has been included in 
the Defense Department Budget every year.
  Today, I am proud to say, between the DoD and NIH, over $600 million 
is being spent on finding a cure for this disease.
  But our success in building our research enterprise will be pointless 
if breakthroughs in diagnosis, treatment and cures are not available 
for patients.
  That is why, a decade ago, as Chairman of the Senate Labor, Health 
and Human Services and Education Appropriations Subcommittee, I worked 
with Senator Mikulski to create a program, run by the Centers for 
Disease Control and Prevention, to provide breast and cervical cancer 
screening for low-income, uninsured women. And last year, I pushed a 
new law to provide Medicaid coverage to women diagnosed through this 
program so they can get the treatment they need.
  But we still have a long way to go. Breast cancer is the second-most 
common form of cancer in the United States, next to skin cancers. 
Approximately 3 million women are living with cancer today, 2 million 
who have been diagnosed, and an estimated 1 million who do not yet now 
they have the disease. If we are going to win the war against breast 
cancer, we've got to be able to detect it early enough to apply the 
latest treatments effectively. We can prolong and save the lives of 
millions of women if the cancer is detected when it is small and has 
not yet spread to other areas of the body. Although not the perfect 
solution, screening mammograms are the best known way to diagnose 
breast cancer and reduce mortality. For example, routine mammograms in 
clinical trials resulted in a 25-30 percent decrease in breast cancer 
mortality for women aged 50-70.

  In 1990, Congress acted to ensure access to screening by creating a 
Medicare mammography benefit and provided adequate payment for 
screening mammography by setting reimbursement for the procedure at 
$55, indexed to inflation. Today that amount is $69.23. Unfortunately, 
this payment has not kept pace with the costs of the procedure, and 
women's access to screening mammography is being curtailed.
  Hundreds of facilities across the country are losing money on 
screening mammography, and since September of 1999, 243 facilities have 
closed their doors; close to 100 of them in the last 5 months. At the 
same time, one million additional women each year need regular 
mammograms.
  To compound the problem, there is increasing evidence of a shortage 
of practicing radiologists and radiology residents willing to conduct 
mammography screening and receive the necessary specialty training. 
Radiologists report that mammography is under-reimbursed and has a 
comparatively higher workload, high malpractice costs and more on-the-
job stress.
  In addition, this shortage of radiologic technologists appears to be 
worsening at the same time as the demand for medical imaging escalates. 
The number of RT trainees who take the certification exams has declined 
dramatically in the past several years, from 10,330 in 1995 to 7,149 in 
2000. Facilities nationwide report an inability to find and keep 
qualified RTs.
  As a result, women in many different parts of the country are having 
to wait many weeks and months to get a mammogram. These kinds of delays 
put women at risk for more advanced and less treatable forms of breast 
cancer.
  Some of my colleagues may have read in TIME Magazine recently about 
Paula Sperling from New York. When she called her local mammography 
facility, they told her she'd have to wait 5 months for her annual 
mammogram, even though she has a history of breast cancer in her 
family. She told TIME, ``Three or four months could mean the difference 
between a tumor that's localized and one that's spread into the lymph 
nodes.''
  In my home state of Iowa, the situation is less dire, but our 
mammography facilities are struggling because reimbursement doesn't 
come anywhere near the costs of providing the service. For example, 
Mercy Medical Center's Cedar Rapids mobile mammography unit serves 
thousands of women in 7 rural counties in the surrounding area. Many of 
these women would find it very difficult, if not impossible, to get 
their mammograms in any other way. But because of low reimbursements, 
this mobile unit lost $75,000 last year; losses that simply cannot be 
sustained. It is a day to day struggle to keep that mobile unit going.
  Congress has a responsibility to make sure our Medicare policy 
ensures that women have access to timely, quality mammography services. 
Our legislation would do the following:
  Increase the Medicare reimbursement for screening mammograms to

[[Page S2399]]

$90 for 2002, based on currently available cost data.
  Increase Medicare graduate medical education funding for added 
radiology residency slots, some of whom will choose mammography as a 
specialty.
  Increase funding for allied health profession loan programs to 
increase the supply of qualified radiologic technicians (RTs) available 
to conduct mammograms.
  In addition, we have included two important studies in our bill. 
Recent research has suggested that the Medicare reimbursement structure 
for physician work undervalues services and procedures done primarily 
in women when compared to similar male-specific procedures. Our bill 
requires the General Accounting Office to further evaluate this 
research and make recommendations to Congress on how to make Medicare 
reimbursement more equitable.
  Also, there is evidence that screening services are undervalued in 
the physician fee schedule relative to other procedures. Given the 
importance of regular screening to prevent and catch disease in the 
early stages, from breast cancer to colorectal and prostate cancer, we 
include a provision in our bill requiring the Medicare Payment Advisory 
Commission, MedPAC, to study this issue and make recommendations to 
Congress.
  Our legislation has the support of the American Cancer Society, 
American College of Radiologists, Society of Breast Imaging and the 
American Society of Radiologic Technologists. I ask unanimous consent 
that their letters of endorsement be printed in the Congressional 
Record. And for the sake of women across America and their families and 
friends, I urge my colleagues to join us in cosponsoring this important 
bill.
  I ask unanimous consent that the text of the bill, be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 548

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Assure Access to Mammography 
     Act of 2001''.

  TITLE I--ENHANCED REIMBURSEMENT FOR SCREENING MAMMOGRAPHY UNDER THE 
                            MEDICARE PROGRAM

     SEC. 101. ENHANCED REIMBURSEMENT UNDER THE MEDICARE PROGRAM 
                   FOR SCREENING MAMMOGRAPHIES FURNISHED IN 2002.

       (a) One-Year Delay of Inclusion of Payment for Screening 
     Mammography in Physician Fee Schedule.--Section 104(c) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554) is amended by striking 
     ``January 1, 2002'' and inserting ``January 1, 2003''.
       (b) Change in Payment Amount.--Section 1834(c)(3)(A) of the 
     Social Security Act (42 U.S.C. 1395m(c)(3)(A)) is amended--
       (1) in the heading, by striking ``$55, indexed.--'' and 
     inserting ``In general.--'';
       (2) in clause (i), by striking ``and'' at the end;
       (3) in clause (ii)--
       (A) by striking ``a subsequent year'' and inserting ``1992 
     through 2001,''; and
       (B) by striking ``that subsequent year.'' and inserting 
     ``that year, and''; and
       (4) by adding at the end the following new clause:
       ``(iii) for screening mammography performed in 2002, is 
     $90.''.
       (c) Effective Dates.--
       (1) BIPA amendment.--The amendment made by subsection (a) 
     shall take effect as if included in the enactment of section 
     104 of the Medicare, Medicaid, and SCHIP Benefits Improvement 
     and Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554).
       (2) Mammography in 2002.--The amendments made by subsection 
     (b) shall apply with respect to screening mammographies 
     furnished during 2002.
       (d) Construction.--Nothing in this section shall be 
     construed as affecting the provisions of section 104(d) of 
     the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554) (relating to payment for new 
     technologies).

          TITLE II--EXPANDED CAPACITY FOR MAMMOGRAPHY SERVICES

     SEC. 201. NOT COUNTING CERTAIN RADIOLOGY RESIDENTS AGAINST 
                   GRADUATE MEDICAL EDUCATION LIMITATIONS.

       For cost reporting periods beginning on or after October 1, 
     2001, and before October 1, 2006, in applying the limitations 
     regarding the total number of full-time equivalent residents 
     in the field of allopathic or osteopathic medicine under 
     subsections (d)(5)(B)(v) and (h)(4)(F) of section 1886 of the 
     Social Security Act (42 U.S.C. 1395ww) for a hospital, the 
     Secretary of Health and Human Services shall not take into 
     account a maximum of 3 residents in the field of radiology to 
     the extent the hospital increases the number of radiology 
     residents above the number of such residents for the 
     hospital's most recent cost reporting period ending before 
     October 1, 2001.

     SEC. 202. ALLIED HEALTH PROFESSIONAL FUNDING.

       Section 757 of the Public Health Service Act (42 U.S.C. 
     294g) is amended--
       (1) by striking subsection (a) and inserting the following 
     new subsection:
       ``(a) In General.--There are authorized to be appropriated 
     to carry out this part--
       ``(1) $55,600,000 for fiscal year 1998;
       ``(2) such sums as may be necessary for each of the fiscal 
     years 1999 through 2001;
       ``(3) $70,600,000 for fiscal year 2002; and
       ``(4) such sums as may be necessary for fiscal year 2003 
     and each subsequent fiscal year.''; and
       (2) in subsection (b)(1)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C), by striking ``, 754, and 755.'' 
     and inserting ``and 754; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(D) not less than $15,000,000 for awards of grants and 
     contracts under section 755.''.

  TITLE III--STUDIES AND REPORTS ON MEDICARE REIMBURSEMENT FOR GENDER-
                    SPECIFIC AND SCREENING SERVICES

     SEC. 301. GAO STUDY AND REPORT ON MEDICARE REIMBURSEMENT FOR 
                   GENDER-SPECIFIC SERVICES.

       (a) Study.--The Comptroller General of the United States 
     shall conduct a study of the relative value units established 
     by the Secretary of Health and Human Services under the 
     medicare physician fee schedule under section 1848 of the 
     Social Security Act (42 U.S.C. 1395w-4) for physicians' 
     services that are gender-specific.
       (b) Report.--Not later than December 31, 2001, the 
     Comptroller General shall submit to Congress a report on the 
     study conducted under subsection (a), together with such 
     recommendations regarding the appropriateness of adjusting 
     the relative value units for physicians' services that are 
     gender-specific as the Comptroller General determines 
     appropriate.

     SEC. 302. MEDPAC STUDY AND REPORT ON MEDICARE REIMBURSEMENT 
                   FOR SCREENING SERVICES.

       (a) Study.--The Medicare Payment Advisory Commission shall 
     conduct a study of the relative value units established by 
     the Secretary of Health and Human Services under the medicare 
     physician fee schedule under section 1848 of the Social 
     Security Act (42 U.S.C. 1395w-4) for screening services that 
     are reimbursed under such fee schedule.
       (b) Report.--Not later than March 1, 2002, the Commission 
     shall submit to Congress a report on the study conducted 
     under subsection (a), together with such recommendations 
     regarding the appropriateness of adjusting the relative value 
     units for screening services that are reimbursed under the 
     physician fee schedule as the Comptroller General determines 
     appropriate.
                                  ____



                                      American Cancer Society,

                                   Washington, DC, March 13, 2001.
     Hon. Tom Harkin,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Tom: On behalf of the American Cancer Society and its 
     more than 28 million supporters, I am writing to thank you 
     for recognizing the importance of assuring that American 
     women have adequate access to mammography and for drafting 
     legislation aimed at addressing this complex issue. We are 
     most grateful for your leadership and commitment.
       As you know, there have been increasing indicators that 
     suggest an erosion in the current capacity to meet the breast 
     imaging needs of American women. We have been troubled by 
     recent reports of problems related to economic pressures, 
     personnel shortages, and a growing disinterest in mammography 
     on the part of practicing radiologists and recent residency 
     program graduates. Unfortunately, we do not yet have much 
     concrete data to illuminate the extent of the problem.
       The Society is currently working in collaboration with the 
     Society of Breast Imaging (SBI) and the American College of 
     Radiology (ACR) to gather data to better understanding the 
     underlying systemic problems that are reflected in a growing 
     number of anecdotal reports about problems with mammography. 
     We are also in the process of convening a series of meetings 
     with other breast cancer advocacy groups to try to answer the 
     questions raised by the recent news reports.
       The Society strongly believes that continued access to 
     quality mammography must be assured and that this issue must 
     be addressed in a timely fashion. Increasing women's access 
     to high quality breast cancer screening is a goal that has 
     long had strong bi-partisan Congressional support, as 
     evidenced by the enactment of legislation in 1990 to provide 
     a Medicare breast cancer screening benefit and the passage of 
     the ``Mammography Quality Standards Act'' in 1992. Congress 
     has also taken steps to increase access to mammography and 
     breast cancer treatment for the medically underserved by 
     establishing the Breast and Cervical Cancer Early Detection 
     Program and enacting the Breast & Cervical Cancer Treatment 
     Act. In addition, thanks to successful

[[Page S2400]]

     public-private partnerships, many women have gotten the 
     message about the importance of regular mammograms. Your 
     support on these issues has been greatly appreciated.
       Now that women are getting the message and seeking out 
     screening services, the country needs to ensure that the 
     capacity to provide mammography services meets the demand. 
     Approximately 40,600 Americans will die this year from breast 
     cancer. We knew that early detection is key to saving lives 
     from breast cancer, and it increases a women's treatment 
     options. Mammography is the only scientifically proven tool 
     currently available to detect breast cancer before the onset 
     of symptoms. The aging of the baby boomer population means 
     that the number of American women requiring regular screening 
     is increasing dramatically at an estimated rate of over one 
     million per year.
       Your legislation, the ``Assure Access to Mammography Act,'' 
     is an important step in addressing these issues. We know that 
     increasing the reimbursement rate and raising the number of 
     radiology residents--measures addressed in your legislation--
     are important components of the mammography capacity issue. 
     We also believe the MedPAC study called for in the bill will 
     lay the groundwork for shoring up future capacity by 
     evaluating whether or not screening services are undervalued 
     in the physician fee schedule.
       Once again, we commend you for your leadership on this 
     critical issue. As our data collection and analysis efforts 
     progress, we look forward to sharing this information with 
     you and working together to ensure that women across the 
     country continue to have access to high quality mammography 
     services. If you or your staff have any additional questions, 
     please contact Megan Gordon, Manager of Federal Government 
     Relations (202-661-5716).
           Sincerely,
                                                  Daniel E. Smith,
            National Vice President, Federal and State Government 
     Relations.
                                  ____



                                American College of Radiology,

                                       Reston, VA, March 12, 2001.
     Hon. Tom Harkin,
     U.S. Senate, Washington, DC.
       Dear Senator Harkin: On behalf of the American College of 
     Radiology (ACR), I would like to commend you on your efforts 
     to improve women's health by introducing the ``Assure Access 
     to Mammography Act of 2001'' and offer the College's full 
     support for the enactment of this legislation.
       As you know, the College has been working closely with you 
     and your staff to address the growing access problem to 
     timely mammography screening. For over a decade, the Congress 
     and the College have recognized screening mammography as an 
     essential element in women's health and have been committed 
     to providing this valuable service. With the enactment of 
     this legislation, that commitment to women's health will 
     continue.
       Raising reimbursement for screening mammography, and 
     maintaining that level of reimbursement, will allow 
     radiologists to continue providing this lifesaving service in 
     a timely fashion and help avoid the delays that have been 
     widely reported in the media. The College also fully supports 
     the provisions in your legislation regarding the need for 
     additional radiologists and associated allied health 
     personnel. In addition, your provisions requesting the study 
     of Medicare reimbursement of gender-specific services and 
     Medicare reimbursement for screening services in general are 
     solely needed.
       Since the College and you share the common goal of 
     continuing to provide timely access to screening mammography, 
     ACR looks forward to continuing our work together to pass 
     this vital legislation.
           Sincerely,
                                           Harvey L. Neiman, M.D.,
     Chair, Board of Chancellors.
                                  ____



                                    Society of Breast Imaging,

                                       Reston, VA, March 12, 2001.
     Hon. Tom Harkin,
     Hart Senate Office Building, Washington, DC.
       Dear Senator Harkin: Mammography can have a significant 
     impact on women's lives. When screening mammography detects 
     breast cancer at an early stage, women have a better chance 
     of survival and an improved quality of life. Early detection 
     may also spare many women from mastectomy. The American 
     Cancer Society, the American Medical Association, and many 
     other medical organizations now recommend that women begin 
     annual screening mammography at age 40 years.
       The number of screening mammograms performed each year in 
     our country has doubled over the past decade. There are now 
     56 million American women age 40 or older. About 30 million 
     women have had a mammogram during the past 2 years.
       The need for mammography is expected to increase even 
     further in the future. Each year, a greater percentage of 
     women in the breast cancer age group follow the mammography 
     screening guidelines. Also, the population of women age 40 
     and older will grow by 1 million each year over the next five 
     years.
       Today, our medical care system is unable to keep up with 
     this increasing demand for mammography by providing this 
     examination in a timely manner. Waiting time for a 
     mammography appointment has increased. Many facilities now 
     report waits of weeks or even months. The underlying reason 
     for these excessively long waits is inadequate reimbursement 
     rates. At current reimbursement rates, mammography usually 
     loses money. The more mammograms performed, the greater the 
     loss. The current Medicare reimbursement rate of $68.00 for a 
     screening mammogram is less than the cost of performing the 
     examination. Reimbursement rates for other health care plans 
     are based upon the Medicare fee schedule. At current 
     reimbursement rates, many hospitals and clinics have been 
     unable to purchase enough mammography equipment, hire enough 
     radiologists and technologists, and pay for enough office 
     space for breast imaging.
       Long waits for a mammography appointment lead to 
     unnecessary anxiety. Some women feel discouraged. Others may 
     even be deterred from having a mammogram. Extremely long 
     waiting times may result in delay in diagnosis and treatment 
     of breast cancer. This can shorten a woman's life.
       If the trend in financial loses from the performance of 
     mammography continues, the availability of this study will be 
     further curtailed. Some hospitals and medical facilities may 
     even be forced to stop performing this examination. And, most 
     facilities cannot afford to expand despite the projected 
     increasing need for mammograms.
       The Society of Breast Imaging supports your proposed 
     legislation. By bringing reimbursement rates in line with the 
     cost of performing mammography, your bill will ensure that 
     American women will have access to this lifesaving procedure.
           Sincerely,
                                        Stephen A. Feig, MD, FACR,
     President.
                                  ____

         American Society of Radiologic Technologists,
                                                    March 9, 2001.
     Hon. Tom Harkin,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Harkin: On behalf of the American Society of 
     Radiologic Technologists (ASRT), a nationwide organization 
     representing more than 87,000 medical imaging and radiation 
     therapy professionals, we would like to express our strong 
     support for the ``Fairness in Mammography Reimbursement Act 
     of 2001.''
       ASRT supports your call for increases in both mammography 
     reimbursement and federal support for allied health 
     professions educational program grants. ASRT recognizes that 
     current reimbursements do not cover costs for performance of 
     these procedures. In addition, shortages of qualified 
     radiologic technologists have had an adverse affect on access 
     to quality mammography services. We appreciate your 
     acknowledgment that the problem of access to quality 
     mammography is both a reimbursement problem, as well as a 
     personnel problem.
       In 1991, you were one of the first Senators to recognize 
     the need to improve access to and the quality of mammography 
     services. Your cosponsorship of the Woman's Health Equity Act 
     of 1991--which ultimately became the Mammography Quality 
     Standards Act (MQSA) of 1992--was an important first step 
     towards improving the quality of radiologic imaging services. 
     An important component of that bill was the establishment of 
     minimum federal standards for radiologic technologists 
     performing mammography services.
       While considerable progress has been made since 1992 in 
     improving the quality of mammography services, we regret that 
     a similar statement cannot be made with respect to other 
     radiologic imaging services. We would therefore like to take 
     this opportunity to bring to your attention legislation we 
     are promoting entitled the Consumer Assurance of Radiologic 
     Excellence (CARE). This legislation is designed to increase 
     the quality of all radiologic services and reduce medical 
     errors by establishing federal minimum standards for 
     education and credentialing of personnel who perform plan or 
     deliver medical imaging procedures or radiation therapy.
       Again, we commend and support your efforts to improve 
     access and availability of quality mammography services and 
     we look forward to working with you on Legislation that will 
     improve the quality of all medical imaging services.
           Sincerely,
                               Michael DelVecchio, B.S., R.T. (R),
                                                   ASRT President.

  Ms. SNOWE. Mr. President, I am pleased to rise today to join Senator 
Harkin and Senator Mikulski as an original cosponsor of the Assure 
Access to Mammography Act of 2001. This bill addresses an emerging need 
in the fight for breast cancer--the need for adequate reimbursement for 
screening mammography in the Medicare Program and the need to preserve 
access to mammographies services for women across the country.
  Mr. President, we are clearly making small gains in fighting breast 
cancer, which is one of the most challenging and daunting health 
problems in America today. There is no question that a diagnosis of 
breast cancer is something that every woman dreads. But for an 
estimated 192,200 American women, this is the year their worst fears 
will

[[Page S2401]]

be realized. One thousand new cases of breast cancer will be diagnosed 
among the women in Maine, and 200 women in my home state will die from 
this tragic disease. The fact is, one in nine women will develop breast 
cancer during their lifetime, and for women between the ages of 35 and 
54, there is no other disease which will claim more lives.
  But the fact is that mammograms are the most powerful weapon we have 
in the fight against breast cancer. They enable us to detect and treat 
breast cancer at its earliest stage when the tumors are too tiny to be 
detected by a woman or her doctor, providing a better prognosis. An 
estimated 30 million mammograms were performed last year at a cost of 
over $2 billion--a valuable down-payment in our fight against an 
unmerciful killer. And due to the aging of the baby boom generation it 
is estimated that more than one million additional women each year will 
need regular mammograms.
  In 1990 we succeeded in making screening mammography the very first 
preventive benefit available under Part B of the Medicare Program, and 
we set the reimbursement level in statute. In 1998, the Medicare 
Program alone provided over 6 million mammography procedures. 
Unfortunately the Medicare payment, which was indexed to inflation 
under the statute, has not kept pace with the actual increase in health 
care costs. Last year the Medicare reimbursement for a screening 
mammogram was $69.23--well under the mean cost of $90 per procedure.
  There is evidence that radiology clinics are closing their doors, and 
that radiologists are no longer able to provide mammography services 
due to the simple fact that providers are not reimbursed enough for 
their work and cannot justify the losses they incur by providing 
mammography services. Over the past 18 months 243 facilities have 
closed their doors; close to 100 of them in just the past four months. 
This is a problem that must be addressed immediately.
  The legislation we introduce today would increase Medicare 
reimbursement for screening mammograms to $90 for 2002, insuring that 
radiologists across the country are appropriately reimbursed for the 
valuable service they provide.
  On March 7, 2001, the Institute of Medicine (IOM) issued a 
fascinating report evaluating the new technologies of mammography 
titled ``Mammography and Beyond: Developing Technologies for the Early 
Detection of Breast Cancer.''
  At the same time, the IOM recommended analyzing current Medicare and 
Medicaid reimbursement rates for mammography to determine whether they 
adequately cover the total costs of providing the procedure. The report 
also recommends that the Health Resources and Services Administration 
(HRSA) undertake or fund a study to analyze trends in speciality 
training for breast cancer screening among radiologists and radiologic 
technologists, and examine factors affecting the decision of 
practitioners to enter or remain in the field.
  We have taken these recommendations very seriously and by introducing 
this legislation today, we are acting to preserve access to 
mammography. The truth is we simply cannot risk slipping back in our 
fight against breast cancer.
  I urge my colleagues to join us in supporting this very important 
bill and work towards passing it this year.
  Ms. MIKULSKI. Mr. President, I rise to join my colleagues Senators 
Harkin, Snowe, Murkowski, Murray, Schumer, and Reid in introducing the 
Assure Access to Mammography Act of 2001. The goal of this bill is to 
help ensure that women have access to screening mammograms.
  Breast cancer mortality has decreased because of early detection, 
diagnosis, and treatment. Mammography is vital to early detection, yet 
I have seen press reports about women having to wait weeks or months 
for a mammogram. In Maryland, waiting times for mammograms at some 
facilities have increased from one to two weeks to six to eight weeks. 
In addition, some wait times have increased from one to two days to two 
weeks for a diagnostic mammogram. In these cases, usually a woman has 
already had a suspicious finding from a screening mammogram and has to 
wait longer to get the results of a diagnostic mammogram to determine 
if she has breast cancer or not.
  I have also heard about mammography facilities closing down because 
they could no longer make ends meet. In fact, a couple mammography 
facilities in the Baltimore area have closed their doors. This 
coincides with a national trend. Over the last 18 months, close to 250 
mammography facilities have closed down, with almost 100 facilities 
closing between October 2000 and February 2001. Women living in areas 
with no or few mammogram facilities are less likely to have mammograms 
than those living in areas with more facilities.
  At the same time, the size of the population requiring annual 
mammograms is increasing about one million per year. The American 
population is aging. There will be 70 million Americans aged 65 and 
over in 2030. Age is also the most important risk factor for breast 
cancer. A woman's chance of getting breast cancer is 1 out of 2,212 by 
age 30. This increases to 1 out of 23 by age 60 and 1 out of 10 by age 
80. More than 85 percent of breast cancers occur in women over the age 
of 50. This means that more and more women will be on Medicare and need 
screening mammograms. Screening mammograms have been shown to reduce 
breast cancer mortality by 25-30 percent in women age 50-70. About 68 
percent of Maryland women age 65 and older had a mammogram within the 
last year. More women will need this screening at the same time that we 
are seeing fewer mammography facilities available to provide this 
valuable service to women.
  Eleven years ago, I introduced the Medicare Screening Mammography 
Amendments of 1990 to provide Medicare coverage of annual screening 
mammography. This bill set out the conditions under which Medicare 
would cover screening mammograms and how they would be reimbursed. My 
legislation was included in the Omnibus Budget Reconciliation Act of 
1990. Before that, Medicare did not cover routine annual screening 
mammograms. The Health Care Financing Administration (HCFA) reimburses 
screening mammograms at a rate of $55 indexed to inflation. This means 
that for 2001, Medicare pays $69.23 for screening mammograms. Last 
year, Congress changed how Medicare pays for screening mammograms. 
Starting in 2002, screening mammograms will be reimbursed through the 
Medicare physician fee schedule like diagnostic mammograms and other 
services.
  Mammography is a unique procedure. Screening mammography has been 
reimbursed differently under Medicare than diagnostic mammography. 
Mammography is also one of the most technically challenging 
radiological procedures. Ensuring the quality of the image is difficult 
and mammograms are the most difficult radiologic images to read. I 
authored the mammography Quality Standards Act of 1992 to set uniform 
quality standards for mammography facilities, personnel, and equipment 
so that women would have safe and reliable mammograms. These standards 
are unique to mammography. A study has found that allegation of error 
in the diagnosis of breast cancer is now the most prevalent reason for 
medical malpractice lawsuits among all claims against physicians and is 
associated with the second highest indemnity payment size.
  Last week, the Institute of Medicine (IOM) released a report entitled 
``Mammography and Beyond: Developing Technologies for the Early 
Detection of Breast Cancer''. Among the IOM's recommendations is that 
HCFA should analyze the current Medicare and Medicaid reimbursement 
rates for mammography, including a comparison with other radiological 
techniques, to determine whether they adequately cover the total costs 
of providing the procedure. The cost analysis should include the costs 
associated with meeting the requirements of the Mammography Quality 
Standards Act. The bill we are introducing today would delay for one 
year (until 2003) the inclusion of screening mammography in the 
Medicare physician fee schedule. This would give time for HCFA to 
collect data and review Medicare reimbursement rates for screening 
mammography before moving it into the physician fee schedule and to 
help ensure a smooth transition into the fee schedule. This is 
important given the unique characteristics of mammography that I

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have already outlined. In the meantime, the bill would increase 
Medicare reimbursement for screening mammograms to $90 in 2002 to help 
decrease waiting times and the closure of mammography facilities so 
that women have timely access to screening mammograms.

  In addition, there is evidence that fewer numbers of radiologists and 
technologists are going into mammography. That's why this bill 
increases Medicare Graduate Medical Education funding for additional 
radiology residency slots and increases funding for Allied Health 
Professions programs to increase the supply of radiologic technologists 
(RTs) able to conduct mammograms. The IOM report last week acknowledges 
this concern by recommending that the Health Resources and Services 
Administration (HRSA) should undertake or fund a study that analyzes 
trends in specialty training for breast cancer screening among 
radiologists and radiologic technologists and that examines the factors 
that affect practitioners' decision to enter or remain in the field.
  Finally, this bill would require a General Accounting Office study of 
the Medicare reimbursement structure for gender-specific procedures and 
require a Medicare Payment Advisory Commission study of Medicare 
reimbursement for screening services. These studies will provide 
important information for Congress and HCFA to consider as we look at 
ways to improve and modernize Medicare.
  I'm pleased that this legislation has the support of the American 
Cancer Society, the American College of Radiology, the American Society 
of Radiologic Technologists, and the Society of Breast Imaging. I hope 
this bill will begin a conversation about the adequacy of Medicare 
reimbursement of screening mammograms. I urge my colleagues to support 
this bill, and I urge my colleagues on the Finance Committee to 
consider this bill as they craft Medicare reform legislation. A decade 
ago Congress provided coverage of annual mammograms to women under 
Medicare. This legislation will help ensure that the promise we made a 
decade ago remains a meaningful promise to current and future Medicare 
beneficiaries. Without it, some women at risk for breast cancer may not 
have access to screening that could detect cancer earlier and help them 
live longer.
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