Most Medicare Providers Falling Short of Quality Reporting Requirements

Fewer than 20% of Medicare providers meet the program's Physician Quality Reporting System requirements, while the rest could face penalties if the current performance trends continue, according to a Harvey L. Neiman Health Policy Institute study published Tuesday in the Journal of the American College of Radiology, The Hill's "Healthwatch" reports.

PQRS is a voluntary program that allows physicians and other medical professionals to receive incentive payments for reporting information on quality measures related to Medicare services (Viebeck, "Healthwatch," The Hill, 1/8).

Providers that currently meet PQRS standards are eligible to receive 0.5% Medicare bonus payments, according to PhysBizTech. However in 2015, providers who do not meet the quality thresholds will begin to face penalties.

For the study, researchers at the Neiman Health Policy Institute analyzed PQRS data from 2007 to 2010. They found that:

• 24% of eligible radiologists met the quality standards;
• 16% of all other providers met the standards; and
• Radiologists who chose registry reporting over claims-based practices were 4.4% more likely to qualify for the bonus payments (Kearns, PhysBizTech, 1/8).

Richard Duszak -- the institute's CEO -- in a statement said radiologists could face more than $100 million in penalties under current trends in 2016, while non-radiology providers could face fines totaling more than $1 billion ("Healthwatch," The Hill, 1/8).

According to researchers, some initial PQRS participants said they faced challenges with compliance because of "internally contradictory program instructions and explanations from CMS." The researchers added that participants "have asserted that the program had little, if any, impact on the quality of their care" (PhysBizTech, 1/8).