JACR: PQRI participation may not yield better physician service quality

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Even when aggressively pursued, Medicare's pay-for-performance program, the Physician Quality Reporting Initiative (PQRI), yields actual physician bonuses far less than those expected, finds the results of a study published in the June edition of Journal of the American College of Radiology.

Richard Duszak Jr., MD, of Mid-South Imaging and Therapeutics in Memphis, Tenn. and Worth M. Saunders, MHA, of the University of Tennessee Health Science Center in Memphis, evaluated physicians' perceptions of the PQRI’s impact on the quality of patient care and compared incremental radiologist work to incremental financial incentives under the program. They noted that no investigations had been previously done comparing actual incremental payment with incremental physician work or evaluating the impact of PQRI participation on the quality of radiologist services.

Duszak and Saunders assessed Medicare PQRI bonus information from 29 radiologists at Mid-South Imaging and Therapeutics over the program’s initial two cycles, and incremental bonus incentive percentages were calculated using total payments from Medicare and from all payors.

After the completion of the two PQRIs, physicians were asked to complete a survey regarding their PQRI participation experience, with questions concerning incremental time required to participate and their perceptions of the program's impact on the quality of delivered care.

After analyzing and comparing the survey results, the authors wrote, “despite ongoing educational and operational initiatives, average physician Medicare PQRI incentives amounted to only 0.36 percent of total practice Medicare payment, well under Medicare's expected bonus of 1.5 percent.” In addition, PQRI bonuses were also found to be less than the estimated 1.5 percent average increase in overall physician work necessary for participation, at 0.11 percent.

A noteworthy finding, according to the authors, was that 76 percent of surveyed physicians perceived that PQRI participation in no way improved the quality of radiologic services delivered. Moreover, in the first cycle, 10 physicians (34 percent) received a bonus, six physicians (21 percent) qualified in the second cycle, and one physician (3 percent) reported a bonus in both cycles.

Duszak and Saunders noted that from the perspective of the physician, it remains unclear whether voluntary participation in aforementioned programs is worth the time, effort or expenses involved. Physicians also remained undecided whether such participation “even results in intended improvements in outcomes or physician service quality.”

“For such programs to engender ongoing physician participation, fundamental changes will be necessary to address discordantly low incentives and perceived lack of benefit to patient care,” concluded the study.