The latest tool from the Neiman Institute provides Medicare benchmark data to help you negotiate bundled payments.
Radiologists do not have to be superstars in data analysis to successfully negotiate bundled payment for services. A new resource developed by the Neiman Health Policy Institute™, ICE-T (Inpatient Cost Evaluation Tool), delivers hard data on inpatient claims collected from Medicare.
This free online tool enables radiology practices and hospitals to compare their own internal costs against national aggregated data for all diagnostic related groups (DRGs), build custom bundled payment models for evaluation, and assess associated costs and risks.
“ICE-T provides national benchmark price points so radiologists can identify specific DRGs they may want to consider when participating in bundled payments. The tool can show radiology practices where they can find real savings and real incentives. At the same time, ICE-T helps radiologists understand the risks associated with participating and identify ways to manage that risk,” says Danny R. Hughes, PhD, Neiman Institute senior director for health policy research and senior research fellow.
ICE-T aggregates data from 2008 to 2013 drawn from total imaging reimbursement, total hospital reimbursement, and the imaging share of reimbursement claims data. With this information, users can analyze multiple variables across DRGs. The tool focuses on value, variance, and volume of imaging episodes and displays results in a clear, interactive graphical format. By comparing their own practice costs against this benchmark data, radiologists will have a strong foundation from which to choose and negotiate bundled payments. “For example, if a practice has average imaging episode costs beneath the ICE-T mean cost for a DRG, this may indicate a good DRG for participation,” Hughes explained. The tool can also help practices assess the risks of participation by analyzing such factors as variance in the cost of a DRG or low volume of episodes.
While the robust data in ICE-T is valuable as a standalone source, the most useful comparisons will be made between the national benchmarks and a practice’s own data, Hughes emphasized. It will be important for practices to work with their hospital to use ICE-T to its fullest potential. As a first step, Hughes suggests obtaining DRG-specific data from the hospital’s IT systems and then examining it side by side with the national benchmark data for the same DRG.
The launch of ICE-T in May coincided with the first mandatory bundled payment rollout by CMS for comprehensive care for patients undergoing joint replacement (CJR). “ICE-T represents many of the services and much of the work the ACR does on behalf of its members. It’s another example of ACR leadership’s thinking several years ahead,” says Richard Duszak Jr., MD, FACR, professor and vice chair for health policy and practice in the department of radiology at Emory University School of Medicine and affiliate senior research fellow at the Neiman Institute. “No one can enter into meaningful negotiations with their health system about the right share of reimbursement unless armed with data.”
Duszak has already shared ICE-T with his practice leadership, senior management team, and analytic team to demonstrate the practice’s position within its own health system, starting with the CJR bundle. “If we find we are doing better in appropriate utilization than other providers in regards to CJR, then we are going to be able to do a deeper dive to see what we are doing right and how to leverage this across other DRGs in the future,” says Duszak. “If we are not doing as well as we could, then this is an opportunity to drill down and evaluate our protocols and, from there, refine and improve practice standards.”
“Change is imminent,” Duszak continues. “Prepare accordingly.” He recommends that radiologists visit the Neiman Institute website (neimanhpi.org) and take advantage of its resources, not only ICE-T but also the Alternative Payment Model Toolkit. “It’s called a toolkit for a reason,” says Duszak. “Radiology practices can use these tools to establish themselves as thought leaders within their health systems with regard to new payment models.”
Future deliverables for ICE-T are underway, including peer-reviewed articles and expanded case studies. “We understand that radiologists are in a challenging environment, and ICE-T provides the data and the information they need to navigate these very choppy waters,” says Hughes. “The Neiman Institute will continually add new data and update this tool to ensure radiologists have the information they need to make the right decisions for their practices.”
By Gene Bailey, freelance writer for the ACR Bulletin