PQRS Payment Penalty Will Become Reality For Most Doctors
Most providers participating in the Medicare program are facing reimbursement penalties due to lack of participation in the Physician Quality Reporting System (PQRS). More than 80 percent of participating providers will face penalties for failing to meet quality thresholds if current performance trends continue, according to a new study.
This will begin impacting reimbursements to providers as the bonus program is converted to reimbursement penalties for failing to meet PQRS requirements. Reimbursement penalties will begin in 2015 for performance, as measured by PQRS, in 2013.
PQRS was introduced in 2007 and is set to become a permanent part of provider reimbursement by 2015. The pay for performance (P4P) component of the Medicare reimbursement formula encourages doctors to improve patient care by following evidence-based clinical procedures. Providers can report performance data in one of two ways; 1) claims based submission, or 2) registry submission.
- Under the claims-based reporting methodology, measures are tied to reimbursement claims for procedure codes linked to specific measures. Data submission is thus the responsibility of the provider or group practice as part of its billing operations.
- With registry reporting, the provider or group practice submits quality data electronically to a CMS-qualified PQRS registry vendor, which archives and analyzes aggregated measure-related data. The registry is then responsible for submitting calculated measure information to CMS on behalf of that physician or practice.
The recent study published by the Journal of the American College of Radiology found that radiologists performed better than other Medicare providers in 2010. Nearly 24 percent of radiologists eligible for PQRS incentives that year met the thresholds compared to 16 percent of others. See the full published study here.
Penalties for nonradiologists could total well over $1 billion if current performance reporting trends continue. Based on the trends analyzed in the study, in 2016 radiologists could face penalties totaling more than $100 million.
Last year, most Medicare doctors who were eligible for quality bonuses did not participate in the incentive program. Many groups such as the American Medical Association continue lobbying officials not to implement the PQRS penalties for 2013.
