SIIM: PQRS—An $111M loss for imaging?

DALLAS—Radiologists may be missing the boat by overlooking the Physician Quality Reporting System (PQRS), “an elegantly simple incentive program made complicated by the government,” C. Matthew Hawkins, MD, radiology fellow at Cincinnati Children’s Hospital Medical Center, said during an educational session at the annual meeting of the Society for Imaging Informatics in Medicine (SIIM).

In a nutshell, the federal PQRS program pays physicians and other providers billing under Medicare part B incentives for reporting certain quality measures. In a familiar spin, the incentives convert to penalties beginning in 2015.

The hitch with PQRS penalties is that 2015 penalties will be based on data reported in 2013.

A survey of the radiology profession indicates 24 percent of radiologists qualified for an incentive program in 2010, collecting a mean incentive of $2,811, and suggesting 76 percent of radiologists will be subject to penalties in 2016. The mean price tag of 2016 penalties is $2,654, with the aggregate cost to the professional totaling a whopping $111,393,067.

The lost dollars aren’t the only dire outcome, Hawkins said. As radiologists lobby Congress about reimbursement cuts and other woes, they lose bargaining clout by not participating in PQRS and leaving more than $100 million on the table.

Participating in PQRS

Participating is PQRS is remarkably simple, according to Hawkins.

Providers can participate individually, and choose which of the nine quality measures pertinent to radiology to report on, or as a group, which requires reporting on three measures. Individual participants must report on 50 percent of patients; group participants must report on 80 percent.

Measures related to radiology include items such as exposure time to fluoroscopy, stenosis measurement in carotid imaging and a reminder system for mammograms. Currently, the government is collecting data; there is no minimum threshold to pass.

There are two options for reporting measures: claims-based, which adds a coding modifier to existing CPT codes; or registry reporting, which entails investing in a vendor system. The advantages of the registry approach include the capability to deliver real-time feedback and more frequent incentive payments.

Hawkins urged radiologists to participate in PQRS to qualify for incentives in 2013, and reminded them they need to report on only one measure on one patient in 2013 to avoid a penalty in 2015.