Most Physicians Not Meeting Medicare (PQRS) Quality Reporting Requirements

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A new study by the Harvey L. Neiman Health Policy Institute shows that fewer than one in five healthcare providers meet Medicare Physician Quality Reporting System (PQRS) requirements, but radiologists are doing slightly better at meeting the requirements than physicians in other fields.

Meeting the PQRS threshold qualifies providers for a half percent Medicare bonus payment. However, in 2015, this bonus will be replaced by a reimbursement penalty for failure to meet the requirements. More than 80% of providers nationwide would face these penalties if CMS applied them now, the Institute's press release said.

According to the study, which analyzed data from 2007-2010, the number of PQRS-eligible, participating, and incentive-qualified radiologists increased steadily for each year, from 28,899 to 44,026 (+52.3%), 6,237 to 16,770 (+168.9%), and 2,026 to 10,450 (+415.8%), respectively. Nearly 24% of eligible radiologists qualified for incentives in 2010, compared to 16% for nonradiologists.

While it is encouraging that radiologists are doing a bit better than nonradiologists in meeting the requirements, it was still a low percentage. Without changes to the existing reporting system, more than 75% of radiologists may face mean penalties of at least $2,654 in 2016, totaling an estimated $111,393,067 for the entire profession, the Institute warned.

“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 the press 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.”

To read the study, click here.