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Breast cancer screening bundled payment model incentivizes cost savings

A DBT-inclusive bundled price was associated with significantly reduced recall rates, 13 percent versus 9.4 percent.

Jeff Lagasse, Associate Editor

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, or DBT.

A new study, published online in the Journal of the American College of Radiology, explores an episodic bundled payment model for breast cancer screening that reflects the emerging widespread adoption of DBT.

It finds that bundled episodic payments are an important type of alternative payment model that incentivizes cost savings within discreet episodes of care, and that this can be more thoroughly applied to DBT cases.


In the earlier JACR study from 2016, the authors explored the feasibility of screening mammography as a potential bundled payment model.

The claims data they used predated the implementation of Current Procedural Terminology and Healthcare Common Procedure Coding System codes to report digital breast tomosynthesis, and so they didn't consider the potential impact of this emerging service on their proposed bundled prices. Since receiving approval from the U.S. Food and Drug Administration in 2011, DBT has gained widespread acceptance.

At Emory University, 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 the new analysis, the authors 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 very similar pre- and post-DBT implementation -- $182.86 in 2013 and $182.68 in 2015.

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 percent versus 9.4 percent.

With or without 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 -- such as reduced time away from work from fewer recalls -- as bundled payment models evolve.


Recent rule changes from the Centers for Medicare and Medicaid Services has once again brought bundled payments into the national spotlight.

There are some concerns and challenges for the healthcare industry, including questions about how smaller-scale HCOs will adapt to increased collaboration requirements, to what extent actual cost savings can be realized through bundling, and concerns about the efficacy of existing IT solutions for enabling the payment models.

Payer motivation to explore bundled payments as a solution to rising healthcare costs remains high, January research found. CMS' renewed interest in bundled payments over the past several months includes the possibility of additional mandatory participation for oncology and other providers.

Twitter: @JELagasse

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