Fighting Commoditization . . .

In my last blog, I introduced the challenge of commoditization of the screening mammogram. This edition will address some of the proactive efforts that centers can make to fight this trend.

The tendency in breast centers for the number of diagnostic patients to be disproportionate to the screening base is a natural phenomenon that is a reflection of market differentiation. In other words, your expertise is recognized by referring physicians so they refer their “problems” to the center. Rather than view this as positive recognition, however, I would suggest that material disproportionality should serve as a red flag warning of a problem.

We have found that the problem has two basic dimensions. The first of these comes from some of the referring physicians themselves who have implemented the delivery of mammography in their practices as a revenue item, and then bid out interpretation to the low bidder. The second--but more important in terms of numbers--is a combination of misunderstanding and lack of attention on the part of physicians who refer diagnostic patients to our centers.

The answer to the first of these is to initally make the difference in quality between center-based breast imaging and low bidder radiology very clear to these physicians and practices. When you get a diagnostic from them in which a cancer is visible on a prior, do not hesitate, physician-to-physician, to point out the missed lesion, perhaps even hinting at their place in the medical-legal liability chain. You need also to go directly after their patients. Women are allowed to self-refer for mammography and should be encouraged to be proactive in selecting this aspect of their care.

The second instance is actually much easier, and will probably provide a greater net yield in terms of screening volume. Here you need to track the source of all diagnostic patients back through the screening exam. If the screening exam for a given patient is an outside exam, then look carefully at the referral patterns of the referring physician and, if you find a pattern of non-referral for screening, you need to dig deeper and determine why you aren’t getting the screening referrals. At the end of this process you’ll probably need to have face-to-face meetings between physicians, and an evidence-based discussion of the importance of excellence in screening mammography.

Yes, this process can be tedious, but your future--not to mention the future of your patients--depends on how successful you resist commoditization in your community. The stakes are very high.