Breast cancer screening provides framework for radiologist-led bundled payment models, study reports

According to a new report by the Harvey L. Neiman Health Policy Institute, mammography may present an opportunity for the expanded use of bundled payments in radiology. The study, published online in the Journal of the American College of Radiology (JACR), reports that breast cancer screening provides a framework for radiologist-led bundled payment models, and can be implemented with different services included in the bundle depending upon a practice's specific patient panel.

"In an effort to curb health care costs and improve the quality of care, bundled payment models are becoming increasingly adopted," said Danny R. Hughes, PhD, Neiman Institute senior director for health policy research and senior research fellow. "To date, these models have focused primarily on treatment episodes and primary care providers. To achieve current Medicare goals of transitioning fee-for-service (FFS) payments to alternative payment models, a broader range of patient episodes and specialty physicians will need opportunities to participate."

Neiman Institute investigators explored breast cancer screening episodes as one such opportunity. The researchers developed a bundled payment model for mammography and calibrated it using Medicare claims data and data from a private health system. Bundles were developed with a screening mammography event and included a variety of downstream diagnostic breast imaging services during a 364-day episode window. While the researchers found considerable variation in imaging care pathways, they discovered that breast cancer screening had the benefit of well-established practice parameters and structured reporting that could reduce the variation.

"As the U.S. health care delivery system transitions from FFS to value based payments, it's important that we [radiologists] are at the table to ensure that our patients have access to high quality imaging," said Geraldine McGinty, MD, MBA, FACR, vice chair of the American College of Radiology (ACR) Board of Chancellors and a member of the Neiman Institute's advisory board. "Shaping payment policy to support that access is at the core of the ACR's mission. Bundled payments are seen by policymakers as a vehicle for aligning incentives and in fact the Centers for Medicare and Medicaid Services (CMS) have now imposed mandatory bundling for joint replacement and cardiovascular care."

McGinty and her co-authors noted that their report does not propose a price that CMS or other payers should pay for a breast cancer screening episode, but provides a framework from which an individual practice might build a model with a payer based on their own individual population and practice.

"Aside from serving as a model to demonstrate how diagnostic radiologists can participate in bundled payment models, this research initiative has the potential to fundamentally change the way mammography is paid for in this country. Because screening bundles include costs for follow-up diagnostic imaging in addition to the initial screening mammogram, patient adherence to screening guidelines may improve - which may have profound effects on public health in a way that's great for patients, providers and payers," said Hughes.