When Medicare launched its Physician Quality Reporting System (PQRS) in 2007, the agency might just as well have come right out and told physicians: Show your quality or forfeit your profitability.
At the time, PQRS’s system of modest bonuses gradually giving way to increasing penalties seemed sufficiently far off to many practices that they thought they could simply ignore the program.
That was then and this is now. Some physicians will soon be taking a hit of up to 4% off Medicare reimbursement. Such will be the payment deduction for physicians who both fail to participate in PQRS at all or perform poorly against CMS’s Value-Based Payment Modifier, which considers both the quality of care provided and the cost of that care relative to the Medicare Physician Fee Schedule.
“PQRS penalty is applied to two years prior, so that means if you were not reporting in 2013, you will recognize the lower reimbursement this year,” said Don Naugler, director of product management, Nuance Diagnostic Healthcare Solutions. “In 2016, based on 2014 PQRS reporting, there is a 2% penalty for failing to report PQRS and a penalty for the Physician Value Modifer, which also carries a maximum 2% reduction.
The good news for radiology is that, compared with other specialties, it’s doing quite well with PQRS participation. Last summer, CMS showed radiology slower to the draw than only four other specialties (internal medicine, family practice, emergency medicine and anesthesiology).
Beyond keeping up
It was within the context of PQRS participation that Naugler presented as a panelist in a Feb. 24 webinar from Nuance, “3 Ways Your Network Can Improve Patient Care.” This session looked at ways radiology practices cannot just keep up with PQRS, but also enhance quality reporting, aid collaboration with the entire care team and improve outcomes—all without disrupting existing workflows.
“There are many different techniques that can be used to submit your PQRS reporting,” Naugler said, pointing to claims-based reporting methods and the group-practice reporting option for larger practices.
Nuance automates the submission of PQRS data through the ACR’s National Data Registry, which recently was approved by CMS as a Qualified Clinical Data Registry for the CMS PQRS program. The service builds on the company’s cloud-based PowerShare network, which is currently supporting the company’s imaging sharing service.
“As we were putting together the PowerShare network, we looked to see beyond image sharing what we could do to leverage the power of connecting all of those people,” Naugler explained. “One of the things that jumped out is the ability to communicate and automate some of the reporting to the regulatory agencies.”
With its history of accrediting thousands of imaging organizations since the 1980s and recent designation as a CMS PQRS data registry, the ACR was a prime candidate for alignment. “We thought that if there was a way to leverage the network to communicate with them, that would be very helpful,” he recalled.
Naugler said at least one report shows that those who report via registry, not just ACR’s but other approved registries as well, have been achieving an 80% success rate at avoiding penalties. By comparison, the claims method is succeeding just 50% of the time.
For those reporting via the claims route, Nuance’s PowerScribe platform is readily available for any and all radiologists using any version of the reporting software. “You could conceivably create your auto templates to include mandatory custom fields so that every time you had an appropriate study—for example, a fluoroscopy exam where you needed patient dose—you could include that and submit through your billing,” he explained. “Your billing office would forward that to CMS and submit for PQRS.”
However, that option doesn’t take advantage of Nuance’s push to automate those pieces, enabling a practice to increase the number of measurements. “The fact is that the ACR’s data registry allows you to open up to additional measurements beyond just the four or five most commonly associated with radiology,” Naugler said. “It allows you to open up to [specialty-specific] measurements that tend to be automated, things like turnaround time.”
Accordingly, Nuance is automating data exchange with the ACR registry for PQRS reporting via the company’s cloud-based image-sharing network, PowerShare, said Naugler. He explained that the network includes an accelerator that extracts