The Breast Screening Bundle Tool

OCT tool

A new resource from the Neiman Institute helps practices estimate prices for breast cancer screening.

A free tool from the Harvey L. Neiman Health Policy Institute®(HPI) offers radiology practices a way to estimate bundled payments for breast cancer screening based on service utilization and reimbursement rates.

The Breast Screening Bundle Tool was released at ACR 2017 in May as a possible solution to the question of how radiologists will get paid under a new federal compensation system.

According to Danny R. Hughes, PhD, HPI senior director for health policy research and senior research fellow, the impending CMS payment change to physicians — known as the Merit-Based Incentive Payment System — has been especially challenging for radiologists.

“In an effort to curb health care costs and improve the quality of care, bundled payment models are becoming increasingly adopted,” says Hughes.

According to Hughes, to date, these models have focused primarily on treatment episodes and primary care providers. For CMS to achieve their goal of transitioning fee-for-service (FFS) payments to Advanced Payment Models (APMs), a broader range of patient episodes and specialty physicians will need to be included in APMs. Radiology-driven APMs, such as the Neiman Institute’s proposed Breast Screening Bundle Tool, may allow radiologists to qualify under an APM rather than struggling with the complexities of MIPS.

“Physicians must have at least 20 percent of their CMS compensation tied to an APM model to qualify,” says Hughes. “The Breast Screening Bundle Tool can help large radiology and multi-specialty practices meet that standard.”

The calculated weighted 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, a referral for biopsy, or positive cancer diagnosis. Practices can enter their own utilization and local pricing data to estimate potential bundled prices for both public and commercial insurers.
The launch of the Breast Screening Bundle Tool follows the publication of a January 2017 Neiman Institute paper1 that found 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.

Geraldine McGinty, MD, MBA, FACR, vice chair of the ACR BOC and a co-author on the 2017 study, believes breast cancer screening is an opportunity for radiologists to excel under APMs. “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,” says McGinty.

 By Nicole Racadag, managing editor, ACR Bulletin

1. Hughes DR, Miao J, McGinty G, Shetty SK, Duszak R. An EmpiricalFramework for Breast Screening Bundled Payments. J Am Coll Radiol. 2017;14(1):17–23.

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