Current Medicare performance metrics favor radiologists in large practices and those in subspecialties, according to a study in the June issue of the Journal of the American College of Radiology, which may hurt general radiologists and impact patient care.
“Generalists seem to be inherently disadvantaged by such measures,” wrote lead author Andrew Rosenkrantz, MD, with the department of radiology at NYU Langone Medical Center and colleagues. “[T]his performance disparity merits closer attention, because these well-intended performance scoring systems could inadvertently incentivize practice changes that compromise patient access.”
Physicians participating in Medicare’s Merit-Based Incentive Payment System (MIPS) receive positive or negative payment adjustments based on their total scores across a range of quality and other measures.
CMS has attempted to provide physicians flexibility in participation by allowing them to select the quality measures for scoring along with the mechanism for doing so. This includes everything from claim-based reporting to qualified clinical data registry (QCDR) reporting.
Rosenkrantz and colleagues used 2015 CMS data that included 15,045 radiologists reporting 40,427 Medicare quality scores. The scores came from 25 claims measures, 18 registry measures and two QCDR measures.
The group found higher performance scores were associated with larger practices, subspecialized practices, academic practices and early career radiologists.
“The strongest predictor was radiologists practice size, which may be related to larger practices having more robust infrastructures for measure identification and reporting,” they wrote. “It may also be driven in part by the more subspecialized nature of larger practices.”
Authors noted that to receive a payment bonus, radiologists need to be aware the scoring system under MIPS, “effectively grades physicians ‘on a curve,’ awarding points on the basis of performance on a decile-based relative scale compared with national performance.” This requires they outperform other physicians on certain benchmarks that may be difficult for measures with higher scores.
The team concluded that improved quality metrics are needed to better reflect the performance of all radiologists.
“We believe that our findings highlight the continued need for radiology professional societies and CMS to work together in developing more meaningful and diverse quality measures for radiologists, so as to positively influence patient care,” Rosenkrantz et al. wrote.