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Care-quality penalties loom for Medicare docs


By Maureen McKinney
Posted: January 9, 2013 - 12:00 pm ET
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Physicians are struggling to meet the targets set by the CMS' Physician Quality Reporting Program, and large numbers could see their future Medicare payments docked as a result, according to a study.

Despite growing participation in the PQRS program since its inception as a pilot in 2007, fewer than one in five eligible and participating providers actually qualified for an incentive payment, according to the study, released by the American College of Radiology's Harvey L. Neiman Health Policy Institute.

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The institute found that radiologists fared better than other physicians, with nearly 24% qualifying for bonuses in 2010 compared with 16% of nonradiologists, the study found.

Under the PQRS program, physicians choose a minimum of three measures from a list of more than 200 and report on at least 80% of their Medicare patient encounters involving each measure. Bonus payments have decreased incrementally each year, dropping from 2% in 2009 to 0.5% in 2013.

Those carrots will soon become sticks as PQRS penalties kick in starting in 2015, when physicians face a 1.5% payment penalty for failing to meet reporting requirements. This year, 2013, is the performance period that will determine 2015's penalty, which makes physicians' lackluster progress so worrisome.

"Near-term improvements in documentation and reporting are necessary to avert widespread physician penalties," Dr. Richard Duszak, the institute's CEO and senior research fellow and the study's lead author, said in a news release. Radiologists could face as much as $100 million in penalties in 2016, and that number could spike to as much as $1 billion for nonradiologists, he added.

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


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