The Neiman Health Policy Institute is at it again, adding yet another online tool to help imaging practices make the right clinical and economic decisions. The institute released the Breast Screening Bundle Tool after a presentation at the American College of Radiology (ACR) Annual Meeting.
“This new tool is designed to help radiology practices develop bundled payment models for breast cancer screening,” said Danny R. Hughes, PhD, Neiman Institute senior director for health policy research and senior research fellow, in a press release. “The calculated bundled prices are a single price for patients that would cover initial mammography screening and all subsequent imaging screening and diagnostic testing for either 364 days after the initial screen or a referral for biopsy or positive cancer diagnosis.”
Practices can include screening mammography plus any mix of seven additional services in the estimate, including breast ultrasound, MRI and digital breast tomosynthesis (DBT). The tool was developed using claims data from CMS 5 percent identifiable files from 2013 to 2015.
The currently available bundled payment models put radiology at a disadvantage: their key focus is to lower the total medical spend, but studies showing the cost-efficiency of imaging interventions are few and far between, according to James Whitfill, MD, Clinical Associate Professor at the University of Arizona College of Medicine. This results in bundled payment models where radiologists are relegated to the sidelines, unable to qualify for the bonus payments that come with utilization of advanced payment models.
However, breast cancer screening is an opportunity for radiologists to own an advanced payment model, according to Geraldine McGinty, MD, vice chair of the ACR Board of Chancellors and a co-author on a study outlining a breast imaging bundle.
“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 and shaping payment policy to support that access,” McGinty said in a press release. “Bundled payments are seen by policymakers as a vehicle for aligning incentives and are currently required by the Centers for Medicare and Medicaid Services for joint replacement care in most major markets.”