With an intensified focus on providing cost effective care, payors are searching for new ways to manage cost. One such effort is the Centers for Medicare and Medicaid Services’ (CMS) Bundled Payments for Care Improvement (BPCI) initiative.
The ACR’s recent publication “A Radiologist’s Primer on Bundles and Care Episodes” provides a brief overview of the expected changes in bundled health care payments and the impact on radiology services. Bundled payments provide a financial incentive to reduce costs and improve coordination of care. This is achieved by setting a price for an episode of care to cover the range of services, including imaging, needed to treat a patient for a particular diagnosis. The price set for an episode of care is based on the diagnosis. A list of CMS defined episodes of care can be found here. We anticipate radiology-only bundles to be developed to cover episodes which rely primarily on imaging services. Seidenwurm and Lexa provide mammography screenings as an example of a potential radiology-only bundle.1 This bundle could include the initial mammography screening, recall diagnostic imaging, and follow up.
Payment models vary on the definition of an episode of care and may cover the initial inpatient stay to post-acute period.2 The models also vary in how payments are provided, retrospectively or prospectively. Bundled payments will require hospitals to determine how the payments are distributed among the different departments providing services.
With bundled payments, radiology departments would receive a portion of the payment for an episode of care. Determining the proportion of the payment for imaging services can be based different factors, such as:
- Average utilization trends per diagnosis.
- Guidelines and evidence-based recommendations for imaging required per episode.
- Imaging results requiring follow up, such as in cancer diagnoses.
Since the goal is to curb costs associated with over-utilization of inappropriate imaging studies, expect payments to reflect an average or lower than average utilization of imaging studies.1
How Can CareSelect Imaging™ Help?
CareSelect Imaging™ incorporates the American College of Radiology’s guidelines into the existing provider workflow to drive the appropriate selection of imaging studies. Clinicians are able to determine the right diagnostic test for their patient at the time of ordering, thereby reducing the number of inappropriate tests.
Next step: Implement relative cost information with CareSelect Imaging™ to promote the use of appropriate diagnostic studies.
With tight reimbursement rates, it is important to help inform your providers about the cost of the studies they order. CareSelect Imaging™ provides an easy to interpret summary about the relative costs of diagnostic tests and promotes the selection of cost-effective imaging studies.
Next step: Customize the CareSelect Imaging™ workflow to alert providers to orders associated with bundled payments.
The CareSelect™ Reporting & Analytics tool provides a focused look at trends and ordering practices. The reporting package provides information on the frequency of an imaging study by a variety of characteristics including by diagnosis or provider. These features help identify areas of opportunity and interventions can be tailored to specific orders.
Next Step: Use the CareSelect™ Reporting & Analytics tool to focus on ordering trends for diagnostic tests when payment bundles have narrow profit margins.