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.

ICE-T Inpatient Cost Evaluation Tool

Interpretation

The Inpatient Cost Evaluation Tool (ICE-T) aggregates multiple years of Medicare inpatient claims data and allows users to examine hospital, physician, and imaging costs across diagnosis related groups (DRGs). ICE-T can be used to identify the best inpatient DRG codes to bundle, and users can both compare and rank DRGs on the basis of several criteria. ICE-T also provides a context for determining the best price at which to bundle a DRG by providing users with detailed information on patient costs as inpatient care continues to shift away from fee-for-service models.

Fee-for-service (FFS) has long been the standard payment model; however, there has recently been a push to explore Alternative Payment Models (APMs).  The ICE-T app was designed with the bundled payments model in mind. The Centers for Medicare and Medicaid Services (CMS) define a bundled payment as “a single payment to multiple providers for an entire episode of care, that is, treatment for a specific medical condition during a set period.”

Bundled payments differ from FFS by using a single flat fee that is reimbursed by the type of episode instead of paying for the cost of each individual service. Choosing whether or not to bundle payments for a DRG requires careful estimations of cost and risk.

There are two tools which users can use to determine the costs for a DRG, including the total cost, the imaging cost, and the share of total costs associated with imaging: the Compare and Rank tools. Users can compare the value, variance, and volume data for up to four DRGs at a time. They can also rank DRGs by several factors to identify the best DRGs to bundle. Depending upon practice size, not all DRGs should be bundled.

Understanding Bundled Payments

Bundled Payment Models

Frameworks for Radiology Practice Participation

Risk Mitigation in Bundled Payments

Using ICE-T To Make a Bundle

Case 1: Which DRG Should a Practice Bundle?

Case 2: Examining CJR Episodes

Methods

 

Useful Links

Alternative Payment Models (APMs): The ACR guide to APMs.

Imaging 3.0™ Toolkit: Imaging 3.0™ provides concrete steps to allow all radiologists to take a leadership role in shaping America’s future health care system.

Neiman Almanac: The Neiman Almanac aggregates multiple years of data from varying data sources to create dynamic tables of both state and national figures on volume, spending, access and workforce of radiology services.

Glossary: Explanations for all the terms used in this Interpretation and the ICE-T app.