In order for the health industry to transition from fee-for-service to alternative payment models, a wider range of specialists and episodes of care have to be involved. According to a new study conducted by the Harvey L. Neiman Health Policy Institute, mammography may provide an opportunity for the expanded use of bundled payments in the radiology field.

Policymakers are viewing bundled payments as a way to align incentives. CMS has already imposed mandatory bundling for joint replacement and cardiovascular care.

The researchers developed a bundled payment model for mammography and calibrated it using Medicare claims data and data from a private health system. They then developed the bundles, which included a variety of diagnostic breast imaging services during a 364-day episode window.
They found that even though there was a substantial variation in imaging care pathways, breast cancer screening involved well-established practice parameters and structured reporting that could reduce variation.

"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," Dr. Geraldine McGinty, vice chair of the American College of Radiology Board of Chancellors and a member of the Neiman Institute's advisory board, said in a statement. "Shaping payment policy to support that access is at the core of the ACR's mission.”

McGinty and her fellow researchers pointed out that the study doesn’t suggest a price that CMS or other payors should offer for a breast cancer screening episode. Instead, it establishes a framework whereby an individual practice can build a model with a payor based on its own population.

Since screening bundles includes the cost for follow-up diagnostic imaging and the initial screening mammogram, the researchers think that patient adherence to screening guidelines might improve.

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