Why Bundled Payment Programs Could Benefit Mammography Services

August 19, 2016 - Bundled payment programs have been used in a wide variety of medical treatments and diagnostics such as joint replacement therapy and, more recently, cardiac care. The Centers for Medicare & Medicaid Services (CMS) has established these bundled payment programs in order to stabilize rising healthcare costs and improve patient outcomes across hospitals around the country.

Currently, CMS has reached their goal of 30 percent Medicare payments being in the form of alternative payment models and is looking to boost this percentage rate to 50 percent by 2018. This has often involved incorporating bundled payment programs among hospitals and physician offices.

Another area that could benefit from implementing a bundled payment program is that of mammography, according to a study from the Harvey L. Neiman Health Policy Institute. The Institute reported in a press release that breast cancer screenings within the radiology field present a beneficial opportunity for utilizing bundled payment programs.

A bundled payment model  used within breast cancer screenings could be tied in with other services that go beyond mammography such as biopsies or CT scans. The research from the Harvey L. Neiman Health Policy Institute was published in the Journal of the American College of Radiology.

With the health insurance industry transitioning away from fee-for-service payment structures toward value-based care reimbursement, bundled payment programs have become more popular among the hospitals, physician practices, and payers. It may be time to expand bundled payment models across more medical services that go beyond primary care and surgical interventions, said Danny R. Hughes, PhD, Neiman Institute Senior Director for Health Policy Research and Senior Research Fellow.

“In an effort to curb healthcare costs and improve the quality of care, bundled payment models are becoming increasingly adopted,” Hughes said in a public statement. “To date, these models have focused primarily on treatment episodes and primary care providers. To achieve current Medicare goals of transitioning fee-for-service (FFS) payments to alternative payment models, a broader range of patient episodes and specialty physicians will need opportunities to participate.”

Researchers from the Neiman Health Policy Institute used claims data and clinical data from a private health system to determine whether bundled payments could be used to cover the costs of mammography. Since bundled payment programs are based on an episode of care, the researchers looked at a time period of 364 days. The episode of care begins with a mammography and continues forward with other breast cancer screening tests.

While a wide variety of variation was found with the regard to breast cancer screenings, the researchers suggest that structured reporting could bring more balance and a more straightforward path toward diagnosing breast health issues.

With CMS creating bundled payment models for cardiac care and joint replacement surgeries, more providers and payers are jumping on the bandwagon of bundled payments since this reimbursement structure could improve patient outcomes by incentivizing greater care coordination among clinicians as well as reducing wasteful spending.

“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,” Geraldine McGinty, MD, MBA, FACR, Vice Chair of the American College of Radiology (ACR) Board of Chancellors and a member of the Neiman Institute’s advisory board, stated in the press release.

“Shaping payment policy to support that access is at the core of the ACR’s mission. Bundled payments are seen by policymakers as a vehicle for aligning incentives and in fact the Centers for Medicare and Medicaid Services (CMS) have now imposed mandatory bundling for joint replacement and cardiovascular care.”

The report does not set a specific price for these bundled payment programs but it does create a framework in which radiologists and their billing departments could follow when contracting with a health plan. Payers and providers could use the framework to determine the most beneficial bundled payment contract to serve their particular population and location.

This type of research could make a significant impact on the way mammography is reimbursed in the future. Bringing bundled payments to more healthcare services could truly transform reimbursement in this country by bringing more focus toward quality of care instead of quantity.

“Aside from serving as a model to demonstrate how diagnostic radiologists can participate in bundled payment models, this research initiative has the potential to fundamentally change the way mammography is paid for in this country. Because screening bundles include costs for follow-up diagnostic imaging in addition to the initial screening mammogram, patient adherence to screening guidelines may improve – which may have profound effects on public health in a way that’s great for patients, providers and payers,” Hughes concluded.

The framework developed by the researchers also focuses on assessing patient risk and the benefits of alternative screening tests alongside mammography. The results from the study illustrate that bringing high-risk patients into the bundle did not make a significant impact on increasing bundle prices.

Another major benefit the researchers uncovered is the potential for increasing patient adherence to breast cancer screenings. Essentially, this bundled payment model could be an important example to follow in other types of episode-based healthcare services.

Dig Deeper:

How to Overcome the Challenges of Bundled Payment Models

How Payers Should Prepare for Value-Based Reimbursement