Diagnostic Radiology Performance in MIPS: Dependence on Non-Radiology Quality Measures and Implications of the...

Medicare adjusts radiologists' reimbursement under the Merit-based Incentive Payment System (MIPS); CMS plans a mandatory transition to MIPS Value Pathways (MVPs), which restrict multispecialty group-level reporting.

To analyze 2023 MIPS performance for diagnostic radiologists, identify structural factors affecting payment adjustments, and estimate the potential impact of the ExRad quality measure (Q494).

Cross-sectional analysis of publicly available 2023 MIPS data for 249,848 physicians, including 25,160 diagnostic radiologists. Radiologists were classified by reporting pattern (mixed, non-radiology only, radiology only, no measures) and by group versus individual reporting. Twenty radiology measures were assessed for topped-out status. A simulation replaced each radiology-only reporter's lowest scoring measure with ExRad at scores of 5, 7, and 9.

Radiologists ranked 28th of 62 specialties in mean payment adjustment (+0.39% versus +0.20%). Mixed reporters (40.1%) had the highest quality score (85.1) and adjustment (+0.90%; 9.8% penalized); radiology-only reporters (15.8%) had the lowest among measure reporters (quality score 71.4; +0.14%; 27.3% penalized). Six of 20 radiology measures were topped-out in 2023, and the most frequently reported measures averaged 5.7-8.3 among radiology-only reporters. Among individually reporting radiologists, 87.3% reported no measures (mean adjustment -1.99%). In simulation, ExRad substitution increased estimated adjustments by 0.15-0.45 percentage points; at a score of 9, 40.0% of penalized radiology-only reporters avoided negative adjustments.

Radiologists' MIPS performance depended on multispecialty group reporting of non-radiology measures, a strategy MVPs will largely eliminate. Modeled estimates suggest ExRad, the sole outcome measure in the 2026 diagnostic radiology MVP, could partially offset this loss.