Bundled Payments: Treat? Or Really Tricky?
Like a sibling Halloween haul swap, radiologist payment in bundled systems requires math and negotiation.
'Tis that time of year again, when neighborhood homes, schools, and local businesses are decorated with ghosts and goblins, spiders and spooks, witches and warlocks. And, of course, there's candy. Lots of candy. So when my kids come home with buckets of the stuff, they cast aside any math aversion and become confectionery accountants, counting and sorting. Then start the obligatory negotiations, wherein sweet treats are traded based on personal preferences ("malted milk balls...ugh"), candy size (full chocolate bar versus so-called fun size), and other assorted parameters of relative candy valuation. The kids have become so skilled at this over the years that they should be recruited for Middle East peace talks or, a little closer to home, to negotiate radiologist reimbursement in bundled payment systems. I truly don't know which would be harder.
Bundling is one type of instrument increasingly used in the inexorable transition from volume-based to value-based payments. What does this mean for radiologists? Well, it depends. The ACR has been looking at a mammography-related bundle, where the radiologist is the responsible provider for an episode of care that starts with mammography and ends with image diagnosis or biopsy. In other words, the radiologist has direct control of the components that make up this image-centric bundle. This is not as complex as a multidisciplinary-care situation, such as stroke, where imaging and radiologists play a critical part, but the radiologist would not be designated the responsible provider. However, in these multidisciplinary cases, clinical complications out of radiologist control could impact how many imaging studies are performed, in contrast to the mammography situation. When it comes to episodes of care that radiologists don't directly control, should radiologists share risk or opt for a fee-for-service contract outside the bundled payment system? I'm grateful that the ACR's Neiman Health Policy Institute is actively engaged in answering timely and challenging questions like these.
On the heels of a recent Radiology Firing Line podcast that included conversation about Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs), Danny Hughes, PhD, from the Neiman Health Policy Institute builds upon that foundation of knowledge, joining host Saurabh (Harry) Jha, MD, to discuss bundled payments in all-new podcast.
To get a small taste of the variability of costs around an episode of care, take a look at the Neiman Health Policy Institute's Inpatient Cost Evaluation Tool (ICE-T). I've just compared imaging costs for different variants of acute myocardial infarction based on Diagnostic Related Group codes. ICE-T is very easy to use and provides you data both in box-and-whisker plot form and as a table.
This is just the tip of the iceberg in figuring out who gets paid how much when it comes to bundled payments. Tricky stuff to be sure. But knowing that Danny Hughes and his colleagues at the Neiman Health Policy Institute have our backs, I'm not afraid of bundled payments. My kids using algebra to calculate the relative value of the one remaining Snickers bar compared to a Reese's peanut butter cup, now that's scary.