Why bundled payments could drive innovation: an example from interventional oncology

Area of Science:

• Interventional Radiology
• Health Economics
• Oncology

Background:

• The fee-for-service (FFS) healthcare payment system in the US may hinder medical innovation.
• Published examples demonstrating this concept are scarce.
• Investigating financial disincentives for novel medical techniques is crucial.

Purpose of the Study:

• To evaluate the adoption and financial implications of an innovative temporary balloon occlusion technique for yttrium 90 radioembolization in liver cancer treatment.
• To compare this technique against the standard coil embolization method.
• To illustrate how FFS models can stifle healthcare advancements.

Main Methods:

• Implementation of a novel temporary balloon occlusion technique for yttrium 90 radioembolization.
• Comparison of patient outcomes, costs, and procedure times with the standard coil embolization technique.
• Financial analysis of revenue generation under the FFS system for both techniques.

Main Results:

• The balloon occlusion technique demonstrated comparable patient outcomes, reduced costs, and faster procedure times.
• Despite clinical benefits, the technique did not achieve widespread adoption.
• Financial analysis showed a significant decrease in hospital and physician revenue due to avoiding a lucrative Current Procedural Terminology (CPT) billing code.

Conclusions:

• The FFS payment system created financial disincentives for adopting the innovative balloon occlusion technique.
• The avoidance of a high-revenue CPT code negatively impacted the new technique's acceptance.
• This case highlights how financial structures within FFS can stifle innovation in healthcare delivery, even when cost-saving and clinically beneficial.