Quality and Imaging: Be at the Table or on the Table

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This article is second in a four-part series on health-care reform and radiology. To read the first article in the series, click here.Ed GainesMissy LovellAs specifics of how health-care reform’s provisions will be executed increasingly come into focus, the radiology industry awaits word on how it will be required to demonstrate quality under the new order. “By 2015, physician payments can be reduced by 1.5% if physicians are not reporting under the Physician Quality Reporting System (PQRS),” according to Ed Gaines, chief compliance officer for Medical Management Professionals, Inc (MMP), Atlanta, Georgia. He says, “We are moving from a pay-for-reporting to a pay-for-performance mentality and payment system.”

Missy Lovell, compliance manager at MMP, adds that the stakes are higher than ever, when it comes to quality, because quality is poised to play a significant role in future reimbursement. While CMS reimbursement will already take a 1.5% hit by 2015 for lack of successful quality reporting, if private payors join the federal agency in linking payment to quality, the ability to demonstrate quality could affect an even larger proportion of a physician’s bottom line. Reporting on quality, at the same time, is only becoming more complex.

“In terms of the PQRS, the measures on which radiology has to report have grown; for 2011, the ACR® has identified approximately 13 measures that are relevant to the specialty of radiology (to include interventional radiology),” Lovell says. “I think that the number of measures relevant to the specialty will grow; in the future, you will see retention of some past measures, new measures added, and revisions added.”

Pay for Reporting to Pay for Performance

Gaines notes that in order to ease physicians into using the PQRS, CMS has allowed them to report quality via claims-based options before moving to registry-based reporting. In 2009, 32% of eligible radiology professionals participated in the program, almost all of whom presumably submitted their data through claims-based reporting; participating radiologists received an average potential incentive payment of $2,772, while participating interventional radiologists received a potential $3,707, on average. “Based on these numbers, radiology professionals are very slowly warming up to the idea of quality reporting, even though the number of applicable measures is expanding,” Lovell says.

She notes, however, that more than 90% of eligible professionals who reported through a registry received an incentive, while only 50% of those who reported through claims did—a discrepancy that is probably owed to errors in claims-based reporting. “There is little payout for a big effort,” she observes. “Many do not go to registries because they do not understand them, and because there are costs associated with their use, thereby reducing what little incentive was obtained.”

Lovell adds that inability to obtain incentive payments is the result, in many cases, of errors made in submitting claims, not of failure to take quality-promoting action in the areas covered by the PQRS. “Therefore, many practices have not bought into doing it yet,” she says.

Although a date has not been set for physicians to move over to pay for performance, Lovell notes, the physician side is generally two to three years behind the hospital side, which will make the change in 2013. “It is probably in the offing,” she says.

Quality Transparency

As pay for performance takes hold, physician reporting data will be posted to Medicare’s Physician Compare website ( www.medicare.gov/find-a-doctor/provider-search.aspx), the partner site of Hospital Compare ( www.hospitalcompare.hhs.gov), where hospitals’ quality data are accessible to the public. Gaines notes that these websites are not without their flaws.

“The Physician Compare website is up, but the data have not been populated, and there are a lot of issues with the accuracy of information there,” he says. “At Physician Compare, they sometimes have old hospitals where providers are no longer working. We are trying to figure out where they are deriving the data, but once they get the wrinkles worked out, needless to say, pay for performance will no longer be just reporting.”

The next question, Gaines predicts, is how important these data will prove to be to the financial health of physician practices. “We have certainly already seen hospitals advertising how they have scored,” he says. “That is the offensive version. It will be interesting