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Using 2016 claims from a representative 5% sample of Medicare beneficiaries

To look at what happens downstream of screening mammography, we used CMS' Standard Analytical Files (learn more about this dataset here). The analysis uses national Medicare claims for a 5% representative national sample of fee-for-service Medicare beneficiaries. The claims follow patients' care through the inpatient, hospital outpatient, and physician office settings.

For our analysis, we started each episode when a patient received a screening mammogram between January 1 and June 30, 2016. We then tracked utilization of diagnostic mammogram, breast or lymph node biopsy, and breast surgery in the six months following the screening mammogram (with the last episodes concluding on December 31, 2016). 

Key findings: Every 100 screening mammograms results in 1 surgery

Within six months of receiving a screening mammogram, about 15% of patients received a diagnostic mammogram—and 65% of those mammograms happened in the hospital outpatient department (HOPD). About 2.5% of screening patients received a biopsy and about 1% received surgery. The vast majority of surgeries took place in the HOPD setting—with far fewer occurring in an office or inpatient setting.

Please note that since this analysis is based off a representative 5% sample of national Medicare beneficiaries, the downstream rates given here should be considered alongside your population's particular clinical and demographic characteristics.

If you're interested in the details of this analysis, including our service definitions, please reach out to me at sauletd@advisory.com.