Most docs not on par with Medicare PQRS quality reporting standards


Fewer than one-in-five providers can claim compliance with Medicare Physician Quality Reporting System (PQRS) requirements, according to a recent Harvey L. Neiman Health Policy Institute report.

Unto those few who currently align themselves with the reporting policies, .5 percent Medicare bonus payments are bestowed, but come 2015 such prizes will transform into penalties for all physicians not up to PQRS par — more than 80 percent of providers nationwide, the study finds.

"Near-term improvements in documentation and reporting are necessary to avert widespread physician penalties. As it stands, in 2016, radiologists collectively may face penalties totaling more than $100 Million. Although not a specific part of this analysis, penalties for nonradiologists could total well over $1 billion," said Richard Duszak, MD, chief executive officer and senior research fellow of the Harvey L. Neiman Health Policy Institute, in a news release. "Compliance with PQRS requirements has improved each year but more physicians need to act now: Their performance in 2013 will dictate penalties for 2015."

Institute analysts examined program data from 2007-2010, coming to the conclusion that 24 percent of eligible radiologists fit the bill for PQRS incentives in 2010; only 16 percent of all other providers were qualified.

Researchers noted that physician struggles and frustrations when attempting to adhere to the PQRS threshold were replete and widespread, even among the reigning radiologists.

“At least some early PQRS participants have expressed frustration with internally contradictory program instructions and explanations from CMS,” the authors wrote. “One practice reported only a minority of radiologists successfully qualifying for bonuses, despite early and aggressive processes to optimize compliance. Many of those radiologists reported that their perceived incremental efforts far outweighed program rewards. This phenomenon is not radiology-specific; a recent study of 8 primary care practices similarly highlighted that startup and maintenance costs sometimes exceed program returns. From a clinical vantage point, and perhaps quite important from the perspective of the improved care that this program was intended to incentivize, a majority of PQRS participants have asserted that the program had little, if any, impact on the quality of their care.”

Study findings of additional importance include:

  • Radiologists availing themselves of registry (rather than claims-based) PQRS reporting were 4.4 times more likely to qualify for incentive bonuses.
  • Without improvements in the quality of physician documentation and practice reporting, more than 75 percent of radiologists could soon be penalized by Medicare. Collectively, those penalties are projected to exceed $100 million.

The study was published online in the Journal of the American College of Radiology.