Medicare testing new breast cancer screening cost measure
Medicare is testing a new breast cancer screening cost measure, the American College of Radiology reported Friday.
The federal payment program and its third-party partner, Acumen LLC, are now sending surveys to imaging groups that administered 10 or more screening mammograms in 2024. They’re seeking to assess whether Medicare has properly allocated spending to cover these encounters, ACR notes.
Participants will receive a report through the Quality Payment Program Portal detailing how CMS calculates and assigns costs to their practice. ACR emphasized this is for testing purposes and will not impact future payments.
“Your feedback is essential because this measure would directly affect breast imagers participating in CMS’ quality payment program, the Merit-based Incentive Payment System (MIPS), which is immediately linked to Medicare Part B reimbursements,” ACR said in its news update Feb. 6. “Radiologists are in the best position to assess whether this measure reflects real‑world screening practice, assigns costs fairly, and avoids holding radiologists responsible for services they do not control.”
Acumen was previously awarded a grant from the Gordon and Betty Moore Foundation to develop these measures aimed at improving breast cancer care. The project seeks to link current practice standards to policy initiatives, creating a cohesive set of measures based around the Breast Imaging Reporting and Data System Atlas. As reported previously, the new measure would assess costs of services that are clinically related to the attributed clinician’s role in managing care during each episode. Measurement would start from the critical event—a screening mammogram, which opens or “triggers” the episode—through 365 days afterward or at the next screening mammogram.
If radiologists fail to submit feedback on the measure, Medicare will assume it is acceptable as written, ACR noted. The college believes this presents a crucial opportunity to help the agency identify issues with how care episodes are defined and costs are attributed. Those who do not directly receive a field test report can submit feedback through the online survey portal until 11:59 p.m. ET on Feb. 27.
CMS and Accumen will be field testing a total of three episode-based cost measures from Jan. 29 to Feb. 27, with the other two relating to non-pressure ulcers and parkinsonism syndromes/multiple sclerosis. Performance scores are combined into an overall MIPS score that determines payment adjustments in subsequent years, Acumen noted. Further information about the breast cancer screening measure can be found here.
The college also is encouraging its members to share redacted copies of their field reports to help it with future advocacy.
“These reports allow ACR to better understand how the measure may affect practices and raise concerns with CMS as needed,” the organization noted.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.