Few Medicare Physicians Meet Quality Thresholds

The vast majority of Medicare providers are not meeting quality thresholds, according to a study by the Harvey L. Neiman Health Policy Institute.

If current performance trends continue, more than 80% of Medicare providers will face penalties for failing to meet the standards of the Physician Quality Report System (PQRS), the study in the Journal of the American College of Radiology revealed.

Physicians who meet the program’s standards are eligible for bonus payments. However, as part of the health care law, Medicare providers who do not meet PQRS’ requirements this year will be penalized.

In 2010 only 24% of eligible Medicare providers chose to participate in the PQRS program. Of those, only 68% qualified. The mean incentive bonus in 2010 was $2,157.36. However, the range was vast: $0.13 to $125,792.80.

Radiologists performed better. According to the study, 23.7% of eligible radiologists qualified for incentives in 2010 compared to just 16.3% of nonradiologists.

“Using 2010 actual physician experience data, and projecting scheduled PQRS annual methodology under steady-state conditions, an estimated 76.3% of radiologists would be subject to mean penalties of at least $2,654 in 2016,” wrote authors Richard Duszak Jr., MD, Judy Burleson, MHSA, David Seidenwurm, MD, and Ezequiel Silva III, MD.

Fines against those who do not meet the requirements would be levied in 2015.

“Physician and practice improvements in documentation and reporting, respectively, will be necessary to avert widespread near-future physician penalties,” the authors of the study wrote.

Read more:

Medicare’s Physician Quality Reporting System: Early National Radiologists Experience and Near-Future Performance Projections — Journal of the American College of Radiology

Study: Most Medicare docs set to face performance penalties - The Hill