Bundled payment models remain feasible after DBT implementation

The continued popularity of digital breast tomosynthesis (DBT) has not made bundled payment models from before the rise of DBT any less feasible, according to a new study published in the Journal of the American College of Radiology.

“With the emergence of alternative payment models (APMs), the radiology community has struggled to determine how best to participate in these new payment systems,” wrote lead author Margaret M. Fleming, Emory University School of Medicine in Atlanta, Georgia, and colleagues. “Radiologists often believe they have little control over costs associated with many diseases and clinical conditions. Lack of data linking imaging with downstream costs and outcomes is an additional challenge for our specialty to meaningful and fairly participate in APMs.”

Fleming et al. sought to explore the feasibility of a bundled payment model for breast cancer screening before and after the implementation of DBT.

The team reviewed data for more than 59,000 screenings from two large facilities within a large academic health system. Excluding DBT, Medicare prices for traditional breast imaging bundles were similar both before (2013) and after (2015) DBT was implemented. 

Before DBT was implemented, a 364-day downstream to screening mammography bundle was $182.86. Following DBT implementation, the researchers found the cost to be $182.68. While the addition of DBT increased a DBT-inclusive bundled price by $53.16, patients experienced decreased recall rates—from 13 percent before DBT implementation to 9 percent after DBT implementation. 

Importantly, the researchers found that with or without DBT, breast screening bundled prices remained sensitive to bundle-included services and didn’t vary much by patient age, race or insurance status.

Additionally, they found that implementation of DBT during screening increases the cost of the bundle but it is still less than the price of DBT itself, making it a cost-effective payment model.

“Our work establishing the feasibility of a screening mammography bundle is an important step in transparency and defining radiologists’ contribution to patient care in a value-based system,” the researchers wrote. 

Fleming and colleagues noted that future work should assess other services, including procedures, downstream to initial and follow up imaging. They added that as bundled payment models evolve, research should focus on societal costs that may occur, including a decrease in time away from work due to fewer recalls

“This type of bundle could serve as the basis for a physician focused payment models, as risk-based contracting with commercial payers, or as a way to quantify shared savings allocation within a larger clinically integrated network or accountable care organization," the authors concluded.