CHICAGO, Nov. 28—When it comes to the 2007 Physicians Quality Reporting Initiative (PQRI) and pay for performance (P4P), “radiologists must play,” said Paul Larson, MD, during the session “Pay and Performance: Can Radiologists Play Too?” at the 93rd annual meeting of the Radiological Society of North America (RSNA).
“We need more data for radiology,” he said. “Why not get paid for collecting it?”
According to Mark Bernardy, MD, FACR, RCC, consumers want healthcare that is “quicker, faster, and better.” He said this “speed as service, consumer directed healthcare, and enhanced information availability will impact pay for performance” – consumers will shop around for their medical care, forcing not just physicians, but radiologists, to offer more value and quality than before.
Currently under the PQRI, Bernardy said a physician can simply collect data and report it, regardless of performance. Bonuses are tied to the individual physician NPI number; paid to the tax identification number assigned the benefits; and physicians are given 1.5 percent of allowed charges for all Medicare. Services paid over the applicable period are subject to a cap, he said.
While this is helpful in creating a registry of information and bonuses, regardless of performance, are an advantage. Larson said the ultimate goal should be to show a commitment to quality, which means a commitment to performance and payment for performance. He said he expects that the realistic outcome of P4P, though, is “increased payments for higher performance, but also lower payments for lower performance.”
Larson said that P4P should “recognize significant distribution of performance in order for it to work. It should be reasonably attainable; should promote quality and improve it; and performance measures will need to evolve or be retired.”
Susan Nedza, MD, of the Special Program Office of Value-Based Purchasing at the Centers for Medicare & Medicaid (CMS), said that quality is not just for physicians anymore, that it “belongs to all of us.” Nedza said that CMS needs input from radiologists to create effective measure sets, which will only be as good as the feedback they receive. “We have a great opportunity to change things—we are the experts,” she said. CMS is currently offering to pay radiologists to learn how to do quality reporting—unfunded mandates are usually more common, she said.
Bernardy said that holdbacks are on the horizon for P4P—when payment is withheld if certain metrics are not met. He said this [PQRI] is the future—now is “the time to learn, when it doesn’t really count.”