Having experienced this first hand with my mother who WAS and the key word is WAS a patient at HUMC- the wait is horrendous, no communication, overbooked and nasty nurses was her opinion…..E. Nigma
Sunday, August 5, 2007
Last updated: Tuesday March 11, 2008, EDT 4:26 AM
LINDY WASHBURN
STAFF WRITER
There’s a waiting room at the hospital breast center where I went for my mammograms. I call it the anxiety room.
It’s for women like me, who’ve already been diagnosed with breast cancer, or for those who need a second opinion or frequent follow-ups.
It’s crowded.
Women in white bathrobes fill almost every seat. They ooze anxiety from every pore.
On my first visit, I thought my 8 a.m. appointment would put me at the head of the line. But several others shared the same slot. One grouched that she had to take a day off every time she came — which was often — because she never knew how long she’d be there.
That’s the dirty secret of breast cancer care around North Jersey these days: The waits to find out if you have cancer and what you should do about it are agonizingly long — and getting longer.
Several free-standing mammography centers have closed, forcing more women to go to busy hospital breast centers for their annual screening mammograms. At Hackensack University Medical Center, for instance, women must book screening appointments five or six months in advance.
As the remaining centers cope with more patients, very few provide results of mammograms while women wait anymore. If news is good, most mail them out within a few days. If a mammogram shows something suspicious, patients are notified quickly, but often have to wait an excruciating week or longer to be squeezed into the schedule for a follow-up test.
“It’s a pretty significant crisis,” says Dr. Gail Starr, director of imaging at the Institute for Breast Care at Hackensack University Medical Center. “It’s definitely a challenge, with these centers closing. Where can they [the patients] go?”
Now comes even more worrisome news: More women are skipping their annual mammograms. It’s a potentially deadly trend, because breast cancer rates had been improving dramatically as a result of the widespread use of mammography.
“Our fear in the breast imaging world is that we’ll lose the gains,” says Melinda Staiger, a member of the American Cancer Society’s regional mammography strike force and a radiologist at the breast care center of Monmouth Medical Center.
Death rates from breast cancer dropped 24 percent from 1990 to 2000, in large part because increased use of mammograms has led to early detection and early treatment.
But women of all economic classes, including those with health insurance and those without, are failing to get their annual mammograms. Shockingly, this even includes cancer survivors. A recent study found that only 55 percent of New Jersey women on Medicare, ages 52 to 69, had had mammograms in the last two years.
Does the wait and inconvenience have anything to do with it? “Nobody knows. … But it’s certainly not the ideal situation,” says Dr. Carol H. Lee, chairwoman of the breast imaging commission of the American College of Radiology and a professor at the Yale University School of Medicine.
Insurers pay too little
Mammography is a procedure proven to save women’s lives, yet the economics of American medicine doesn’t support it.
Radiologists say that managed-care plans and Medicare, which insures those over 65, pay them less than the actual cost of a screening mammogram.
My initial screening mammography, the one that changed my life, was reimbursed by a private insurer at exactly $92.31. That’s not enough, says Staiger, to cover the cost of producing and interpreting the film. And there are no economies of scale: “The more you do, the more you lose,” she says.
Small wonder that hospitals, increasingly, are becoming the main centers for mammography. For a hospital it’s a loss-leader: screening procedures inevitably lead to a certain number of profitable surgeries and cancer treatments.
Englewood Hospital and Medical Center’s mammography business grew by 7 percent last year — to 18,700 mammograms — and 12 percent the year before. The Valley Hospital’s grew 17 percent, to 11,000 annually. Hackensack’s breast center does 40,000 mammographies every year.
“It seems like every few months, I hear of a place that is not doing this anymore,” says Dr. Edward Lubat, Valley Hospital’s director of body imaging and managing partner at Radiology Associates of Ridgewood.
Mahwah Radiology closed on April 30. Some of their 5,000 patients will go to another facility owned by the same partners in West Paterson, but others will transfer elsewhere.
“We’re very sad to be closing this down,” says Melody Sanchez, the office manager. “Financially, it was not feasible to continue operating.” Insurance payments for a screening mammography usually ran less than $100 a case, she says.
The final blow, says Dr. Orestes Sanchez, a radiologist and co-owner of the center, was the 3.5 percent tax the state levied on ambulatory services centers to balance the state budget last year.
“That was the only profit I had,” he says. In April, he had to take out a personal loan to pay the tax.
Two or three afternoons a week this summer, his wife, the manager, has carted old mammography films to the lobby of the former Mahwah office to give patients their files.
In Fairview, Superior Medical Imaging stopped offering mammography services in the spring, when its mammogram technologist quit. The cost to replace her was more than the center could earn by providing the service, says Lisa Gagliano, the owner and administrator. They resumed last month anyway, because of the demand from doctors who refer patients.
“The government should step up to the plate,” with adequate reimbursement rates, Gagliano says.
Last year, Clifton Radiologist Associates on Route 46 closed; Montvale Radiology closed before that. In July 2005, Dr. Noah Weg abruptly closed his mammography practice in Suffern, N.Y.; only when Good Samaritan Hospital took custody of the patient records did women gain access to their X-rays.
Across New Jersey, the number of mammography machines in use has dropped from 504 to 375 in the past three years as centers have closed, says Jill Lipoti, director of environmental safety and health for the state Department of Environmental Protection, which regulates the service.
Meanwhile, other centers have been cited for poor-quality work. Two non-hospital mammography centers were barred from performing mammograms in recent months after federal investigators said the images taken there posed a serious risk to the health of patients.
Nearly 1,100 women — patients of Hackensack Medical & Molecular Imaging, on State Street, and Englewood Imaging Center, on North Dean Street — were notified that federal regulators were concerned about the quality of their mammograms. They were advised to repeat them or have the films reevaluated. Englewood corrected its problems and was allowed to resume performing mammograms in April.
Even hospitals aren’t immune: Federal investigators discovered that St. Mary’s Hospital in Passaic performed mammographies for four months with faulty quality-control equipment. The hospital hadn’t repaired the part because it didn’t have the money.
After the investigation, the equipment was fixed quickly and mammography services resumed.
Radiologist shortage
As mammography centers struggle with low reimbursements, they’re also competing to hire doctors and technologists who specialize in breast imaging.
The number of radiologists specializing in the field is not keeping up with demand. Three out of 10 mammography practices in 2003 reported job vacancies. The number of physicians working in the field has dropped steadily since 1999. The Society of Breast Imaging says that two-thirds of training positions for future specialists go unfilled because fewer and fewer radiology residents want to go into breast imaging.
Englewood hospital spent more than six months this year looking for two specialty radiologists for its breast center, says Dan Markham, the hospital’s vice president.
The work is stressful and the risk of malpractice is high.
“There are very few other areas of imaging where you’re dealing day in and day out with cancer or no cancer,” Lee says. “If I read chest X-rays, it’s pneumonia or not. If I read bone X-rays, I see fractures. We’re dealing with women who are understandably anxious and upset. It can be very nerve-racking.”
Nowadays, hospitals have to pay attention to the stress of their technologists and doctors. Hackensack medical center could add to the 40,000 cases annually at its Institute for Breast Care, but doesn’t want to cause staff burnout, says Starr, the hospital’s director of imaging.
The need to see more women faster has forced most centers to take the reading of mammograms “off line,” so their physicians can read a stack of X-rays in one sitting, rather than while the patient waits.
“Our volume shot up so much that we couldn’t cope with giving the results right away,” says Dr. Kyunghee Choi, director of Pascack Valley Hospital’s breast center. Now, patients get the results within a week or so.
While women find the wait stressful, doctors say the delays are not cause for alarm. “To tell you the truth, I wouldn’t want my mammography done online,” Lee says. “I want my radiologist sitting in a dark room,” reading a pile of films with total concentration.
“Most tumors in the breast have been there a while,” Starr says. “Waiting a week or waiting 10 days is not the end of the world.”
For women who don’t mind paying cash for the service, there are a handful of boutique centers that offer same-day results and face-to-face consultations with radiologists. But they don’t deal with insurance plans.
The consolidation of mammography services at hospitals is also a good idea, to some.
“I would never let my wife go to a free-standing mammography center,” says Francisco Rodriguez of Goldsmith Richman & Harz, a medical malpractice firm in Englewood Cliffs. “These centers have traditionally been more likely to have radiologists reading mammograms who were not appropriately trained or who just do not have the experience in reading them. The malpractice rates are reflective of this sad fact.”
Schedule far ahead
No matter how comfy the robes, or plush the carpeting, anxiety is inescapable.
My stomach lurched after I went in for my first round of pictures at 9:30 that morning. The technologist returned to say she needed “a few more pictures” — this time of my other breast, the one that supposedly didn’t have cancer. My films were being made to determine how extensive my surgery should be. They’d be read while I waited, but it would take a few hours.
I waited again after that for ultrasound imaging. The radiologist told me her concerns about the other side had been unwarranted. I felt lucky to be finished by lunchtime.
Another woman at the same center drives up from South Jersey, where she moved when she retired, for her semiannual mammograms. She’s had many close calls and is followed carefully. One day last month, she had eight breast X-rays, one ultrasound, two fine-needle aspirations of her right breast, one core biopsy on her left breast and two more X-rays.
It took five hours. Five days later, she learned no cancer was found.
“As anyone who has had to wait for the results of medical tests can attest, these are the longest days of our lives,” she says.
I’m not even midway through my treatment for breast cancer, but I’ve already got a date for my next mammogram. At the end of a post-op visit, my surgeon told me when I should be checked again.
“Make your appointment now,” the nurse said. “They’ve very busy.”
So I’m booked — for next April.
E-mail: washburn@northjersey.com
YOU CALL THIS HEALTH CARE?! 