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The Harvey L. Neiman Health Policy Institute® studies the value and role of radiology in evolving health care delivery and payment systems, including quality based approaches to care and the impact of medical imaging on overall health care costs. Neiman Institute research provides a foundation for evidence-based imaging policy to improve patient care and bolster efficient, effective use of health care resources. Read the 2016 Neiman Institute Annual Report.

The Breast Screening Bundle Tool was developed using the method detailed in Hughes et al. An Empirical Framework for Breast Screening Bundled Payments. JACR, 2017. 14(1): 17-23.

 

Data: Medicare Patient Cohort

This tool was developed using carrier claims data from the Centers for Medicare and Medicaid Services (CMS) 5% Research Identifiable Files (RIF) from 2013-2015, the most recent years available. The CMS RIF data contain all fee-for-service claims associated with a 5% national sample of Medicare enrollees.  The patient population was limited to female patients who:

  1. Underwent a screening mammogram at some point in 2014,
  2. Were alive at the end of 2015,
  3. Resided in the 50 US states and the District of Columbia,
  4. Maintained continuous Part A and Part B Medicare enrollment both 12 months prior to and following the initial 2014 screening mammogram

 

Breast Screening Episode Endpoints

Episode Trigger

Breast screening episodes are triggered with a single mammography screening event. If a patient underwent multiple screening mammograms in the same year, the first screening mammogram in 2014 was identified as triggering the episode.

Episode Closing Rule:

The closing rule for mammography episodes was defined as the earlier of either:

  1. 364 days after the initial screening event, or
  2. The date prior to the last screening mammography in the 364 day period if the patient had a subsequent screening mammography after 11 months but before 364 days after the initial screen.

All mammography and related breast imaging services occurring within the episode trigger and closing rules were identified and defined as the care pathway for the mammography episode.

 

Calculating Mammography Bundled Prices

The reimbursement for each breast related imaging service was taken from the national 2017 Medicare Physician Fee Schedule (MPFS) reimbursement rates.

For each distinct service, we multiplied the service reimbursement rate by the number of services performed. The total reimbursement for all services was then summed and divided by the number of patient episodes, defined by the number of screening mammograms.  We estimated global bundle prices by adding the technical component bundle price and professional component bundle price.

 

Breast Screening Bundle Tool Default Values

The default values assume that all services are included in the bundle. If practices wish to remove specific services from the bundle, entering values of “0” in either “Percentage of Patients Undergoing” or “Number of Services” for the services they wish to remove will calculate appropriate bundled prices.

As previously mentioned, the default reimbursements are derived from the national MPFS rates. Users can directly adjust these rates to reflect their locality specific reimbursements or alter the percentage of MPFS rate, e.g. 200% of the MPFS rate, to calculate potential bundle prices for commercial insurers.