Medicare has begun testing a new episode-based cost measure for breast cancer screening, according to the American College of Radiology (ACR), as the federal program evaluates whether it is accurately accounting for the costs of screening mammograms.
The Centers for Medicare & Medicaid Services (CMS), working with its third-party contractor Acumen LLC, is distributing surveys to imaging practices that performed 10 or more screening mammograms in 2024. The initiative aims to assess whether Medicare spending has been appropriately attributed to providers involved in these screening encounters.
Participating practices will receive a detailed cost report through the Quality Payment Program Portal outlining how CMS calculates and assigns expenses to their services. ACR stressed that the effort is strictly for testing purposes and will not affect current or future Medicare 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 a Feb. 6 update. “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 previously received funding from the Gordon and Betty Moore Foundation to develop episode-based cost measures designed to improve breast cancer care. The initiative seeks to align clinical practice standards with health policy, using the Breast Imaging Reporting and Data System (BI-RADS) Atlas as a foundation.
Under the proposed framework, the cost measure would evaluate services clinically related to the attributed clinician’s role in managing care during a defined episode. Each episode would begin with a screening mammogram—the triggering event—and extend for 365 days or until the patient undergoes another screening mammogram.
ACR warned that if radiologists do not provide feedback, CMS will consider the measure acceptable in its current form. The organization views the testing period as a critical opportunity to identify potential flaws in how care episodes are defined and how costs are assigned across providers.
Practices that do not receive a field test report can still submit feedback through the online survey portal until 11:59 p.m. ET on Feb. 27.
The breast cancer screening measure is one of three episode-based cost measures CMS and Acumen are field testing between Jan. 29 and Feb. 27. The other two focus on non-pressure ulcers and parkinsonism syndromes or multiple sclerosis. Performance across these measures contributes to an overall MIPS score, which determines Medicare payment adjustments in future years.
ACR is also urging members to share redacted versions of their field test reports with the organization to support ongoing advocacy efforts.
“These reports allow ACR to better understand how the measure may affect practices and raise concerns with CMS as needed,” the college said.
