Bundled payment model for breast cancer screening is realistic, study finds

Previously established frameworks for creating breast cancer screening bundled payment models are achievable, according to a new study published in the Journal of the American College of Radiology. The approaches could also incorporate the rise of digital breast tomosynthesis (DBT).

In the study, researchers set out to evaluate the feasibility of a mammography bundled payment model and how a model for breast cancer screening created prior to widespread DBT adoption would fare after institutions have embraced the breast cancer screening method.

Comparing more than 59,000 screening exams from two large facilities, the team found that without DBT, Medicare-normalized prices for traditional breast imaging bundles were “extremely similar” before and after DBT was implemented. In 2013, before DBT, a 364 day downstream mammography bundle was $182.86 compared to the 2015 post-DBT implementation cost of $182.68.

They also found there was not much difference in price across patient race, age and payer populations. This finding, paired with the success of screening bundled payments after DBT was implemented suggest such a model could be executed, wrote first author Margaret M. Fleming, MD, with Emory University School of Medicine in Atlanta, and colleagues.

“As payers and policymakers alike seek to identify episode- and specialty-specific (alternative payment model) APMs for demonstration projects, those observations together suggest that such efforts focusing on breast cancer screening could be meaningful, generalizable, and executable,” they wrote.

Fleming and colleagues did determine that when DBT was added, the price of DBT-inclusive bundles rose by $53.16. However, this rise was less than the price of DBT itself. The authors suggested this may be due to the reduced recall rate associated with the DBT bundle (9.4 percent), compared to the 13 percent rate in 2013, prior to DBT.

The study results may not be generalizable in other locations due to differences in patient populations—one limitation of the research, according to the authors. Additionally, bundle prices were determined based on national average 2015 Medicare Physician Fee Schedule (MPFS) pricing, therefore other systems may need to assess local price adjustments and their own reimbursement rates during that time.

The results are an important step on the path toward value-based care, Fleming et al. added.

“Our work establishing the feasibility of a screening mammography bundle is an important step in transparency and defining radiologists’ contribution to patient care in a value-based system,” the group concluded. “This type of bundle could serve as the basis for a PFPM, as risk-based contracting with commercial payers, or as a way to quantify shared savings allocation within a larger clinically integrated network or accountable care organization.”