For a number of years, Medicare has been warning healthcare professionals that incentive payments associated with the Physician Quality Reporting System (PQRS) program will disappear. There is an additional Value Based Modifier program (VM) that is being implemented in conjunction with PQRS that may cause additional penalties for providers. Providers who do not participate in the PQRS and VM program will be subject to penalties between 2% and 6% of their total Medicare payments depending on practice size. With the amount of money at stake with the PQRS program, radiologists can no longer afford to ignore the program.
There are a large number of changes to the PQRS/VM program for 2015. The impact of these changes to diagnostic radiologists is minimal; the impact of these changes to interventional radiologists and radiologists who bill for patient visits is substantial. A summary of the most important changes is below.
- PQRS penalties are now 2% of total Medicare payments; PQRS incentive payments are gone.
- VM payment adjustments range between -4% and +4% depending on the group size.
- Radiologists can avoid PQRS and VM penalties by reporting on 9 PQRS measures (as long as 9 measures apply). If less than 9 measures apply, the radiologist must report on all applicable measures.
- Diagnostic radiologists likely will not need to add any PQRS measures beyond the measures that they are already reporting.
- Interventional radiologists’ traditional PQRS measures have now been reduced to only 5 measures (the 2 vertebroplasty measures are gone, and the fluoroscopy measure can be considered a diagnostic or interventional radiology PQRS measure). In order to reach the 9 PQRS measure/cross-cutting measure requirement, interventional radiologists will need to consider adding PQRS measures associated with patient visits.
- If a radiology group is comprised of a significant number of radiologists who bill for patient visits and vascular interventional studies, that group may wish to consider reporting using the Group Practice Reporting Option (GPRO) through a PQRS registry.
- Radiologists also now have the option to report via a Qualified Clinical Data Registry administered by the American College of Radiology (ACR). Further information regarding QCDR reporting can be found on the ACR website.
Wendy Driscoll, MBA
Senior Client Manager