More women getting screened for breast cancer as CMS’s shared-savings program matures

Crunching the data on screening mammography utilization in the wake of the establishment of Medicare’s Shared Savings Program, researchers at Johns Hopkins have found what they’re calling “small but significant” improvements:

From 2012 to 2014, participating ACOs grew their screening volumes by a mean of 2.6 percent, and a comfortable majority (128 of 208 ACOs, or 61.6 percent) documented at least some growth, the researchers report online, ahead of print, in Radiology.

Anand K. Narayan, MD, PhD, and colleagues drew baseline information from publicly available data on study-relevant, unidentifiable Medicare patients, of whom there were around 5.3 million across 333 participating ACOs.

Focusing on the percentage of women aged 40 to 69 years who underwent screening mammography during the period under review, the team found that screening use varied across ACOs (median, 63.0 percent; range, 8.8 percent to 90.3 percent).

They also found differences across regions, with highest use in the Midwest (66.6 percent) and lowest use in the South (58.2 percent).

Commenting on the 2.6 percent mean increase and 61.6 percent majority-improvement figures noted above, Narayan and co-authors note that these findings “were in contrast to findings of prior reports on screening mammography in traditional fee-for-service populations in which use was unchanged or declined over the same time.”

The team found no longitudinal differences in across regions, year of entry, number of beneficiaries or total composite quality score.

Nor was there a difference between ACOs that saved money and those that did not.

The authors point out that CMS’s Shared Savings Program, which launched as part of the Affordable Care Act, is the largest value-based reimbursement program in U.S. history.

“Considerable differences were noted from baseline, with increases of up to 42.2 percent in the use of screening mammography; these increases are comparable to some of the most successful previously described multifactorial interventions to improve screening mammography,” they write.

In a press release sent by Radiology publisher RSNA, Narayan says pay-for-performance incentives in ACOs “can facilitate collaboration amongst various stakeholders across the healthcare continuum to improve mammography screening utilization and other key population health metrics, results which will become increasingly relevant as imaging reimbursements transition from fee-for-service to alternative or value-based payment.”