Medicare's physician quality reporting initiative: incentives, physician work, and perceived impact on patient care

The aims of this study were to compare incremental radiologist work to incremental financial incentives under Medicare's Physician Quality Reporting Initiative (PQRI) and to evaluate physicians' perceptions of the program's impact on the quality of care.

Medicare PQRI bonus information was acquired for 29 radiologists from a single practice over the program's first two cycles. Incremental bonus incentive percentages were calculated using total payments from Medicare and from all payers. Physicians were surveyed regarding incremental time required to participate and their perceptions of the program's impact on the quality of delivered care. Incentive data and survey results were analyzed and compared.

Despite ongoing educational and operational initiatives, mean physician Medicare PQRI incentives amounted to only 0.36% of total practice Medicare payment, well under Medicare's expected bonus of 1.5%. As a percentage of collections from all payers, PQRI bonuses amounted to just 0.11%, well less than the estimated 1.5% mean increase in overall physician work necessary for participation. Only 10 (34%) and 6 (21%) radiologists received bonuses each cycle, respectively, and only 1 (3%) achieved bonuses for both cycles. Most physicians (76%) perceived that PQRI participation in no way improved the quality of radiologic services delivered.

Even when aggressively pursued, Medicare's pay-for-performance program, PQRI, yields actual physician bonuses far less than those expected, more than an order of magnitude less than requisite incremental radiologist work, with little reported impact on 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.