Stingy Medicare Rates Risk Women's Health

Government health insurance pays so little for the newer and more accurate Pap test for cervical cancer that many health care providers do not use them.

Judith DeSarno, President, NFPRHA

Millions of American women are being denied the benefits of a new, more accurate test to detect cervical cancer because the federal government will not pay the full cost-the result of the government's low payment schedule for the test says, Judith DeSarno, president of the National Family Planning and Reproductive Health Association, a Washington, D.C., group that represents about 4,200 family planning clinics.

Though the Food and Drug Administration approved the new test in 1996, calling it “significantly more effective” than the standard Pap test, ThinPrep is not widely used because it costs almost twice as much as the conventional Pap test, DeSarno adds.

Costs for a ThinPrep lab test range from about $30 to $60, yet Medicare pays only from $14.60 in Virginia to $31.20 in Connecticut.

Anita Greenberg, a health insurance specialist for the Health Care Financing Administration, which oversees Medicare, says that Congress set the $14.60 minimum reimbursement rate for ThinPrep last November. The less-than-full-payment reimbursement is not unusual, she said.

“ThinPrep payment rates are still being developed by managed care insurers and Medicare. It's new technology. It takes a while for people to feel comfortable setting payment rates,” says Greenberg. She also notes that the lack of trained technicians to read ThinPrep tests has driven up its cost.

Medicare reimbursement rates are particularly important because private insurers often follow Medicare's lead on what to pay for these services, according to DeSarno. The less-than-full payment for ThinPrep is particularly disturbing because the new Pap test-if performed regularly and assessed properly-can prevent nearly all deaths from the disease, she says.

Each year, about 12,800 women are diagnosed with cervical cancer and about 4,800 women die from the disease, according to the American Cancer Society.

The organization's concern about the reimbursement rates for ThinPrep was first made public by DeSarno's report, “The Nickel-and-Diming of Women's Health.”

The same report noted a University of Washington study published in the March 1997 issue of “Gynecologic Oncology,” which found that Medicare reimbursement was 44 percent higher for male-specific procedures when compared to similar female-specific procedures.

The study-which matched procedures so the amount of work and level of difficulty would be identical or similar for the male and female procedures-showed that Medicare paid $131 for a prostate biopsy but only $68 for a biopsy of the cervix in 1995. That's a 93% difference.

The authors also found that Medicare paid 60 percent of the costs for obstetrics and gynecology practices compared with 91 percent for urology and 106 percent for general surgery.

About 50 million women rely on annual Pap tests to alert their physicians to the possibility they may have cervical cancer. However, the standard Pap test fails to detect abnormal cells in about half the women who have abnormal cell growth, according to the U.S. Agency for Healthcare Research and Quality.

With the ThinPrep method, the cervical cell sample is collected in the traditional manner with a cotton swab or small cervical brush. But unlike the conventional method, which destroys up to 80 percent of the cells when they are smeared on a slide, the ThinPrep technique saves virtually all of the cells for analysis by placing them in a preservative.

ThinPrep instruments then rinse the specimen to remove blood, mucus and other debris and make it easier for trained technicians to apply a thin and uniform layer of cells on a slide for examination under a microscope.

In assessing the quality of the ThinPrep method, the Agency for Healthcare Research and Quality reported a recent study that compared the clinical results of 56,000 ThinPrep patient specimens to 75,000 conventional Pap smear samples.

The researchers found a 72 percent increased detection of low-grade lesions and a 103 percent increased detection of high-grade lesions. Moreover, specimen quality was improved by more than 90 percent.

DeSarno says that to date no one has calculated the savings that could result from the widespread use of ThinPrep tests. Nevertheless, she notes, “The key point not to lose sight of is that cost alone should not be the final determinant.” She adds that the new test could save lives and dramatically reduce the number of women requiring extensive treatment for cervical cancer.

Melinda Voss is a free-lance writer based in Minneapolis, with a specialty in health policy issues. She has a master's degree in public health and teaches journalism courses at the University of Minnesota.