Tuesday, 09 June 2015 21:39

CMS Issues PQRS Scorecard: Impressive Participation by Radiologists

Written by Jeff Majchrzak, BA, CIRCC, RCC, Vice President, Clinical Consulting Services – Radiology

j majchrzakUntil otherwise notified by the Centers for Medicare & Medicaid Services (CMS), it will be business as usual for the following programs through the end of 2018: the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Incentive Program, and Physician Value-Based Modifier (VBM) Program. Eligibility differs for each Medicare quality reporting program.

Participation by radiologists in the PQRS has been high, according to a report recently issued by CMS. Table A8 in the report, titled "2013 Reporting Experience Including Trends (2007–2014)," shows the percentage of radiologists (known as eligible professionals, or EPs, in the program) who participated in PQRS in 2013 and thus will receive incentive payments in 2015. These figures are provided in Table 1 below.

Table 1: 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 as well. In fact, they were among the top five specialties with a high percentage of participation, as shown in Table 2 below.

Table 2: Specialties with Highest Participation

Specialties Percentage Reporting 2013 Measures
Pathology 78.7%
Emergency medicine 74.2%
Radiology 73.2%
Interventional radiology 71.5%
Anesthesiology 71.5%

When asked to speculate why the remaining 25-plus percent are not participating in the PQRS, Judy Burleson, the American College of Radiology's (ACR) senior advisor of quality metrics, stated:

"There may be a relatively small number of radiologists that 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."

Complicated Computations

To explain, between July 1, 2007 and Dec. 31, 2014, the Medicare program provided monetary incentives to EP solo practitioners and group practices that satisfactorily reported data on quality measures for covered Part B professional services or 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 VBM program for 2015 and beyond.

By not reporting quality data in 2013, physicians face the PQRS reporting penalty in addition to the value-based purchasing (VBP) modifier penalty (which uses PQRS quality-measure performance rates) in 2015, Burleson explained. And, she says, "this percentage will keep climbing each year, and the amount of those penalties will increase between 2015 and 2018 to a substantial level."

Help for Beginners

To avoid negative payment adjustments, all physicians must be convinced to report quality measures during the next several years. The recently passed Medicare Access and CHIP Reauthorization Act (MACRA) makes 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 an article on the ACR website, "requirements to avoid the 2017 payment adjustment (-2.0 percent), based on 2015 reporting, are the same as for gaining the 2014 incentive with several additional requirements." For those requirements, and for additional guidance on becoming a participant, go online to http://www.acr.org/Quality-Safety/Quality-Measurement/PQRS.

About the Author

Jeff Majchrzak , BA, CIRCC, RCC, is vice president of clinical consulting services – radiology, for Panacea Healthcare Solutions. In Jeff's 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, and in correct coding practices. Jeff contributes to numerous MedLearn Publishing (a division of Panacea) publications and is a sought-after national speaker on coding and reimbursement for radiology, interventional radiology, nuclear medicine, and cardiology.

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Last modified on Tuesday, 09 June 2015 22:04