Most physicians do not meet Medicare quality reporting requirements

January 8, 2013

A new Harvey L. Neiman Health Policy Institute study shows that fewer than one-in-five healthcare providers meet Medicare Physician Quality Reporting System (PQRS) requirements. Those that meet PQRS thresholds now receive a .5 percent Medicare bonus payment. In 2015, bonuses will be replaced by penalties for providers who do not meet PQRS requirements. As it stands, more than 80 percent of providers nationwide would face these penalties.

Researchers analyzed 2007-2010 PQRS program data and found that nearly 24 percent of eligible qualified for PQRS incentives in 2010—compared to 16 percent for other providers. The Neiman Institute study is published online in the Journal of the American College of Radiology.

"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, and senior research fellow of the Harvey L. Neiman Health Policy Institute. "Compliance with PQRS requirements has improved each year but more physicians need to act now: their performance in 2013 will dictate penalties for 2015."

More information: www.jacr.org/article/S1546-1440(12)00473-5/fulltext

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