0:00

Okay, tips for implementation and

0:03

we're very getting towards the end.

0:06

So important.

0:07

This was an issue.

0:08

There is no billing code

0:12

So we needed to create a self-pay and we had

0:16

to work very carefully with legal because

0:18

the patients have to sign an awareness that

0:21

they have to pay out of pocket for this.

0:23

So that's very, very important.

0:25

And that took a long time

0:26

actually at our institution.

0:28

Again, I emphasize this before working with

0:30

your techs on scan efficiency, do those recons.

0:33

After the patient's off the table, so you can

0:35

get the next patient and turn it over quickly

0:38

work with scheduling to triage the patient.

0:41

So they get to the appropriate protocol.

0:42

That's very, very important.

0:44

Do they actually qualify for

0:47

a full protocol based on risk?

0:50

I'm sure you may have heard that there's a lot

0:52

of legislation going on to allow more women

0:55

with dense breasts, particularly extremely

0:58

dense breasts to have insurance coverage for.

1:02

Uh, full protocol M.

1:03

R.

1:04

Um, that's happening across the country.

1:06

It's happening pretty quickly in Pennsylvania.

1:08

So we're going to have to be very

1:09

careful in our triaging of patients.

1:12

Um, recommend risk assessment

1:14

at the time of screening.

1:15

So you get women into the right protocol.

1:18

The full versus the abbreviated, and we really

1:21

ask these patients to bring prior mammograms.

1:23

If they're out of our network, and we

1:24

don't have their mammograms because it

1:26

does help to correlate the mammogram with

1:28

the interpretation of any breast MRI.

1:33

Here's an interesting paper that came out

1:37

fairly recently about how much are women.

1:40

willing to pay for breast MRI.

1:42

And again, this was a single institution

1:44

survey done in 2019 to 2020, um, asking about

1:49

both, um, contrast-enhanced mammo and MRI and

1:52

how much they'd be willing to pay for these

1:55

contrasts, these, um, you know, dynamic studies.

1:57

Um, they had a pretty good completion rate and

2:00

53% of the women who completed this had

2:03

dense breasts and a good group of them,

2:05

almost 14% had had a prior contrast study.

2:08

Um, 35% were satisfied

2:12

with mammography for screening and the major

2:14

negative or neutral part about these extra

2:17

studies were contrast, claustrophobia, false

2:20

positives, of course, you know, extra exposure

2:23

with the contrast-enhanced mammo, not with the

2:26

MRI, of course, and having an IV, et cetera.

2:29

So, things to think about, but the majority

2:32

just over, um, about 55 percent were willing

2:35

to pay at least 250 to 500 dollars out

2:38

of pocket for MRI when they did not meet

2:41

the criteria for insurance reimbursement.

2:43

I will tell you that our site.

2:45

We looked at reimbursement for or average

2:50

out of pocket payment for full, uh, M.

2:52

R.

2:53

as well as supplemental screening

2:55

with ultrasound, et cetera.

2:58

And in general, things were around

3:00

300 or a little bit over 300, 325.

3:03

So we went low and I was very lucky

3:05

to have a collaborative chair.

3:07

We charged 299 out of pocket.

3:10

Um, at our site for our abbreviated protocol.

3:12

I'm not sure that makes us any money, but, um,

3:14

it does get a lot of abbreviated MRIs performed.

3:17

These are questions.

3:18

It's scheduling.

3:19

You might be interested in and these

3:21

are things are we've worked with our

3:22

schedulers to try to triage patients to

3:24

the right, um, study, you know, they may,

3:27

uh, really be eligible for a full protocol.

3:30

Um, they may not want to pay out of pocket.

3:32

We do right now have a grant

3:34

for, um, African American women

3:36

91 00:03:37,730 --> 00:03:40,079 to get abbreviated MRIs for free.

3:40

That's because we were finding

3:41

there were access issues.

3:43

Um, and that's an ongoing project.

3:44

But anyway, um, making sure that they

3:46

have dense breasts, um, et cetera, just

3:49

questions that you may be interested for

3:51

your reference and we made this card.

3:55

Um, we've had different variations of

3:57

this card, but this is an information

3:59

card that we put in primary care

4:02

offices, referring physicians' offices.

4:05

We have them in our waiting room in our mammo

4:07

suite so that if women want to ask questions

4:11

and want to read about this, and then if we meet

4:14

a woman for a diagnostic or for screen, and we

4:16

really think she would benefit from this, we hand

4:18

her this card and it tells you how to schedule.

4:21

Um, and answer some of the very typical questions.

4:24

And we worked with, um, you know,

4:27

our, our department and advertising

4:30

for this just some numbers over time.

4:34

You can see we started in

4:35

January 2016 on the left.

4:38

I have by month.

4:39

You can see the dip there, um, right here.

4:42

This is COVID.

4:44

Nothing was happening for those 2 months.

4:46

Unfortunately.

4:47

Um, and then we started back up and here we are.

4:50

Through May 2023 on the right is

4:53

the studies by year again, went down

4:55

a little bit during COVID years.

4:57

Um, so you can see, we do a pretty brisk

4:59

volume, um, of these in our network.

5:03

So in summary, um, I think, I hope I've

5:06

demonstrated to you that, uh,

5:09

MR breast MR is the most sensitive, most

5:10

modality for the detection of breast cancer.

5:13

And I really believe that abbreviated

5:16

protocols have a very similar

5:17

sensitivity to the full protocols.

5:19

And I think there may be an improvement in

5:21

specificity, but we need to get more data on that.

5:24

But I, I think I actually may be there.

5:27

So abbreviated MR breast MRIs have improved

5:30

efficiency and maintain accuracy

5:34

and therefore may allow more women access.

5:38

And I think that is so important.

5:40

I think this is going to be the supplemental

5:42

screening modality of the future.

5:44

I do think you still need the mammogram to know,

5:46

and preferably a tomosynthesis to go with it.