May 22, 2017 — A new free resource allows radiology practices to estimate professional, technical and global bundled prices for breast cancer screening bundles using different assumptions for which services are included, service utilization and reimbursement rates. Developed by the Harvey L. Neiman Health Policy Institute, the Breast Screening Bundle Tool was presented at the American College of Radiology (ACR) annual meeting, May 21-25 in Washington, D.C.
“This new tool is designed to help radiology practices develop bundled payment models for breast cancer screening,” said Danny R. Hughes, Ph.D., Neiman Institute senior director for health policy research and senior research fellow. “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.”
According to Hughes, practices can enter their own utilization and local pricing data to estimate potential bundled prices for both public and commercial insurers. Practices can also choose which services to include in a bundle by assigning values of zero to any services in the tool they wish to exclude.
The launch of the tool follows the publication of a Journal of the American College of Radiology (JACR) paper, which found 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. The tool was developed using carrier claims data from the Centers for Medicare and Medicaid Services (CMS) 5 Percent Research Identifiable Files (RIF) from 2013-2015, the most recent years available.
“As the U.S. healthcare delivery system transitions from FFS [fee-for-service] 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,” said Geraldine McGinty, M.D., MBA, FACR, vice chair of the ACR Board of Chancellors and a coauthor of the JACR study. “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.”
For more information: www.neimanhpi.org