GE Healthcare Camden Group Insights Blog

Study: Most Medicare Docs Set to Face PQRS Performance Penalties

Posted by Matthew Smith on Jan 10, 2013 12:41:00 PM

PQRSA new study shows that more than 80% of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue.

The Harvey L. Neiman Health Policy Institute found Tuesday that fewer than one in five Medicare providers meet the program's Physician Quality Report System (PQRS) standards and are eligible for related bonus payments.

This point spells trouble for Medicare providers as the bonus program is converted to penalties for failing to meet PQRS requirements this year, researchers wrote. 

"Near-term improvements in documentation and reporting are necessary to avert widespread physician penalties," said Richard Duszak, CEO of the Harvey L. Neiman Health Policy Institute, in a statement.

"Compliance with PQRS requirements has improved each year but more physicians need to act now: Their performance in 2013 will dictate penalties for 2015."

The requirements encourage doctors to improve patient care by following evidence-based clinical procedures, such as administering aspirin to someone suffering a heart attack or ordering a tuberculosis screening for rheumatoid arthritis patients.

The new study found that U.S. radiologists performed better than other Medicare providers in 2010, with nearly 24% of imaging docs eligible for PQRS incentives that year compared to 16% of others.

"As it stands, in 2016, radiologists collectively may face penalties totaling more than $100 million. Although not a specific part of this analysis, penalties for nonradiologists could total well over $1 billion," Duszak said.

Doctor groups like the American Medical Association have urged federal health officials not to implement the PQRS penalties for 2013. The fines would be levied in 2015.

Last year, most Medicare doctors who were eligible for quality bonuses did not participate in the incentive program at all.

Tuesday's study was published online in the Journal of the American College of Radiology.
The Harvey L. Neiman Health Policy Institute studies issues relevant to that field.

Topics: Medicare, Physician's Quality Report System, Research, PQRS

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