Nav: Home

Bundle payment model analysis of emerging breast cancer screening

March 04, 2019

Bundled payments have been touted as mechanisms to optimize quality and costs. A prior feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). A new study, published online in the Journal of the American College of Radiology (JACR), explores an episodic bundled payment model for breast cancer screening that reflects the emerging widespread adoption of DBT.

"Bundled episodic payments are an important type of alternative payment model (APM) that incentivize cost savings within discrete episodes of care," said the new study's lead author Margaret Fleming, assistant professor of radiology and imaging sciences at Emory University. "More recent interest has been expressed in developing outpatient imaging-based cancer screening episodes."

In the earlier 2016 JACR study, Hughes and colleagues explored the feasibility of screening mammography as a potential bundle payment model. The claims data they used predated the implementation of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to report digital breast tomosynthesis (DBT), and thus did not consider the potential impact of this emerging service on their proposed bundled prices. Since receiving approval from the US FDA in 2011, DBT has gained widespread acceptance.

In Fleming's large academic health system, screening mammography is performed at outpatient sites affiliated with four separate hospitals, which have all now since adopted DBT as part of routine screening. For this analysis, Fleming and colleagues focused on the two large hospitals that had no DBT capabilities in 2013, but which subsequently performed DBT routinely as part of their screening examinations in 2015 (2014 was a transition year for both).

"Excluding DBT, Medicare-normalized bundled prices for traditional breast imaging 364 days downstream to screening mammography are extremely similar pre- and post-DBT implementation- $182.86 in 2013; $182.68 in 2015," stated study senior author Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. "The addition of DBT increased a DBT-inclusive bundled price by $53.16--an amount lower than the $56.13 Medicare allowable fee for screening DBT but was associated with significantly reduced recall rates 13.0% versus 9.4%." Without or with DBT, screening episode bundled prices remained sensitive to bundle-included services and varied little by patient age, race, or insurance status.

Based on their findings, the authors concluded that non-DBT approaches to bundled payment models for breast cancer screening remain viable as DBT becomes the standard of care, with bundle prices varying little by patient age, race, or insurance status. Higher DBT-inclusive bundled prices, however, highlight the need to explore societal costs more broadly (eg, reduced time away from work from fewer recalls) as bundled payment models evolve.
To obtain a copy of the study or to arrange an interview with a Neiman Institute spokesperson, contact Nichole Gay at (703) 648-1665 or

Harvey L. Neiman Health Policy Institute

Related Breast Cancer Screening Articles:

Open-access genetic screening for hereditary breast cancer is feasible and effective
Offering open-access genetic testing for the inherited breast cancers BRCA1 and 2 to Ashkenazi women unaffected by cancer, regardless of their family history, enables the identification of carriers who would otherwise have been missed.
Physician breast cancer screening recommendations amid changing guidelines
Disagreement persists between professional societies and organizations over the best time to start and to discontinue mammography for breast cancer screening, as well as the optimal amount of time between screenings.
Screening MRI benefits women at average risk of breast cancer
MRI screening improves early diagnosis of breast cancer in all women-not only those at high risk-according to a new study from Germany.
Breast cancer screening associated with substantial overdiagnosis
Breast cancer screening in Denmark was associated with a substantial increase in the incidence of nonadvanced tumors and DCIS but not with a reduction in the incidence of advanced tumors.
How breast cancer screening could be better and less painful
The breast cancer screening tests offered to women may in many cases be unnecessarily painful.
New report presents bundled payment model for breast cancer screening
According to a new report by the Harvey L. Neiman Health Policy Institute, mammography may present an opportunity for the expanded use of bundled payments in radiology.
Experts assess changes to breast cancer screening recommendations
A new article discusses the evidentiary support for the recent changes made by the American Cancer Society in its recommendations for breast cancer screening.
Breast cancer screening accuracy and time spent evaluating mammograms
Longer time spent by film readers interpreting screening mammograms did not result in a reduced rate of breast cancer detection, according to a study appearing in the May 10, 2016 issue of JAMA.
Breast density and outcomes of supplemental breast cancer screening
In a study appearing in the April 26 issue of JAMA, Elizabeth A.
USPSTF final recommendations on breast cancer screening
The US Preventive Services Task Force published a final recommendation statement on screening for breast cancer following an in-depth review of the science on the benefits and harms of screening mammography, and a detailed review of input received from the public and health care professionals on its 2015 draft recommendation.

Related Breast Cancer Screening Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...