Medicare's Physician Quality Reporting System: early national radiologist experience and near-future performance projections

Purpose: The aim of this study was to examine radiologists' experiences during the first 4 years of Medicare's national physician pay-for-performance program and project near-future program outcomes for radiologists.

Methods: Medicare Physician Quality Reporting System (PQRS) program data from 2007 through 2010 were analyzed, focusing on outcomes and trends for radiologists. Tiered scenario modeling was used to project potential near-future radiologist outcomes as the program transitions from bonuses to penalties.

Results: Between 2007 and 2010, PQRS eligible, participating, and incentive-qualifying radiologists increased 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. Mean 2010 incentive bonuses ranged from $2,811.39 for diagnostic radiologists to $12,704.38 for radiation oncologists. Only 23.7% of eligible radiologists (10,450 of 44,026) qualified for incentives in 2010, but this compared favorably with 16.3% for nonradiologists (158,393 of 973,638) (P < .0001) and represented a marked increase from just 2,026 in 2007. Registry reporting more frequently resulted in incentive payments than claims-based reporting (odds ratio, 4.40; 95% confidence interval, 4.03-4.80). Without physician, practice, or program changes, 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.

Conclusions: Only a minority of radiologists successfully qualified for incentives under PQRS, but that number has increased each year. Those using registry (rather than claims-based) reporting systems were more likely to receive bonuses. Physician and practice improvements in documentation and reporting, respectively, will be necessary to avert widespread near-future physician penalties.