Rads could face payment cuts of 8.5% by 2019

Practices should not delay implementation of quality initiatives mandated by the Patient Protection and Affordable Care Act (PPACA) as bonuses for compliance will soon evolve into penalties for nonparticipation, according to an article published in the November issue of the Journal of the American College of Radiology.

Ezequiel Silva, III, MD, of the University of Texas Health Science Center at San Antonio, explained that with the re-election of President Barack Obama, the PPACA will not face repeal. “PPACA is not going away and is already having profound effects on the current and future payment structure for radiology.”

Of the effects the reform bill has already had on radiology, Silva pointed to reductions in the technical component payment for radiology services through an increase in the technical component multiple-procedure payment reduction and the establishment of the 75 percent equipment utilization assumption for advanced imaging equipment.

“The savings from both of these payment reductions were removed from the Medicare Physician Fee Schedule for use by the General Treasury to pay for PPACA's other provisions, such as expanded insurance coverage and the Medicaid expansion,” wrote Silva.

Looking ahead, Silva explained that PPACA transforms the currrent Physician Quality Reporting Initiative into the Physician Quality Reporting System (PQRS), and with the name change comes a shift from a system that pays bonuses for reporting quality metrics to a system that imposes penalties for not reporting. Radiologists will see a 1.5 percent penalty on Medicare Physician Fee Schedule Payments starting in 2015, though those penalties will actually be based on radiologists meeting the PQRS quality metrics as early as 2013, according to Silva.

The PPACA also mandates the establishment of a value based payment modifier (VBM) in 2015 and allows for a 0.5 percent bonus for Maintenance of Certification (MOC) participation. “It is important for radiologists to recognize the cumulative effect of these pay-for-performance penalties. When PQRS, VBM and MOC are combined with the maximum potential penalty for failure to demonstrate meaningful use, payment reductions could be as high as 8.5 percent by 2019," wrote Silva. "Accordingly, it is becoming harder for practices to delay implementing these initiatives.”