Medicare's Physician Quality Reporting System: early national radiologist experience and near-future performance...

The aim of this study was to examine radiologists' experiences during the first 4 years of Medicare's national physician pay-for-performance program and project near-future program outcomes for radiologists.

Medicare Physician Quality Reporting System (PQRS) program data from 2007 through 2010 were analyzed, focusing on outcomes and trends for radiologists. Tiered scenario modeling was used to project potential near-future radiologist outcomes as the program transitions from bonuses to penalties.

Between 2007 and 2010, PQRS eligible, participating, and incentive-qualifying radiologists increased each year, from 28,899 to 44,026 (+52.3%), 6,237 to 16,770 (+168.9%), and 2,026 to 10,450 (+415.8%), respectively. Mean 2010 incentive bonuses ranged from $2,811.39 for diagnostic radiologists to $12,704.38 for radiation oncologists. Only 23.7% of eligible radiologists (10,450 of 44,026) qualified for incentives in 2010, but this compared favorably with 16.3% for nonradiologists (158,393 of 973,638) (P < .0001) and represented a marked increase from just 2,026 in 2007. Registry reporting more frequently resulted in incentive payments than claims-based reporting (odds ratio, 4.40; 95% confidence interval, 4.03-4.80). Without physician, practice, or program changes, more than 75% of radiologists may face mean penalties of at least $2,654 in 2016, totaling an estimated $111,393,067 for the entire profession.

Only a minority of radiologists successfully qualified for incentives under PQRS, but that number has increased each year. Those using registry (rather than claims-based) reporting systems were more likely to receive bonuses. Physician and practice improvements in documentation and reporting, respectively, will be necessary to avert widespread near-future physician penalties.