Participation by radiologists in the U.S. government's Physician Quality Reporting System (PQRS) has been high, according to a report recently issued by the U.S. Centers for Medicare and Medicaid Services (CMS). Leading the pack are interventional radiologists, with nearly three-quarters participating.
PQRS is part of a CMS initiative to promote higher quality in healthcare. It encourages healthcare providers to report information on their success in meeting quality metrics to Medicare, giving them the ability to see whether they meet best practices. Starting in 2015, CMS will cut payments to providers who aren't reporting quality data for Medicare Part B services in the Medicare Physician Fee Schedule.
As noted in the table below, PQRS participation by radiologists has been rising steadily since 2010, with interventional radiologists taking the lead. Those who participated in the system in 2013 will receive incentive payments in 2015.
| PQRS participation by radiologists | ||||
| Specialties | 2010 | 2011 | 2012 | 2013 |
| Interventional radiology | 39.4% | 44.8% | 58.1% | 71.5% |
| Nuclear medicine | 23.8% | 25.3% | 42.7% | 59.3% |
| Radiation oncology | 22.4% | 28.7% | 43.8% | 60.9% |
| Radiology | 41.3% | 48.2% | 59.3% | 73.2% |
An impressive percentage of diagnostic radiologists and interventional radiologists reported quality measures in 2013. In fact, they were among the top five specialties in terms of participation, as shown in the table below, which lists the percentage of radiologists (known as eligible professionals [EPs] in the program) who participated in PQRS in 2013 and thus will receive incentive payments in 2015.
| Medical specialties with highest PQRS participation | |
| Specialties | Percentage reporting 2013 measures |
| Pathology | 78.7% |
| Emergency medicine | 74.2% |
| Radiology | 73.2% |
| Interventional radiology | 71.5% |
| Anesthesiology | 71.5% |
Judy Burleson, the American College of Radiology's (ACR) senior advisor of quality metrics, was asked to speculate why the remaining radiologists are not participating in PQRS.
"There may be a relatively small number of radiologists who do not have applicable measures, but it is more likely that most of the radiologists who didn't participate in 2013 were not aware of the program, or did not see it as worth the burden of reporting -- at least at the penalty amount (or loss of incentive) associated with the 2013 reporting year," she said.
Complicated computations
To explain, between July 1, 2007, and December 31, 2014, the Medicare program provided monetary incentives to eligible professional solo practitioners and group practices that satisfactorily reported data on quality measures for covered Part B professional services, or that satisfactorily participated in a Qualified Clinical Data Registry (QCDR). Although 2014 was the last year for a PQRS incentive, there is potential to obtain an incentive under the Physician Value-Based Payment Modifier (VBM) program for 2015 and beyond.
Jeff Majchrzak of Panacea Healthcare Solutions.By not reporting quality data in 2013, physicians in 2015 face the PQRS reporting penalty in addition to the value-based payment modifier penalty (which uses PQRS quality-measure performance rates), Burleson explained.
"This percentage will keep climbing each year, and the amount of those penalties will increase between 2015 and 2018 to a substantial level," she said.
Help for beginners
To avoid negative payment adjustments, all physicians must be convinced to report quality measures during the next several years. The Medicare Access and CHIP Reauthorization Act (MACRA) makes it clear that Congress expects CMS to expand and improve current quality measures under the new Merit-Based Incentive Payment System (MIPS) program. It seems obvious that there's no time like the present to begin the transition.
According to ACR's website, "Requirements to avoid the 2017 payment adjustment (-2.0%), based on 2015 reporting, are the same as for gaining the 2014 incentive with several additional requirements. ..." For those requirements and additional guidance on becoming a participant, go to ACR's PQRS Overview page.
Jeff Majchrzak is vice president of clinical consulting services, radiology, for Panacea Healthcare Solutions. In his role as consultant, he conducts CPT coding assessments for both hospitals and physicians, evaluates administrative policies and procedures, and helps develop quality assurance programs to ensure complete and compliant coding and billing. Jeff trains both radiology and cardiology staff (on both technical and professional billing issues) in correct coding practices. Jeff contributes to numerous publications by MedLearn Publishing (a division of Panacea) and is a sought-after national speaker on coding and reimbursement for radiology, interventional radiology, nuclear medicine, and cardiology. Jeff can be reached at [email protected], or visit Panacea Healthcare Solutions at www.panaceahealthsolutions.com.
The comments and observations expressed herein are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
