Monday, April 1, 2013

Majority of Medicare Providers Face Penalties under PQRS Standards

There’s developing news regarding the ongoing battles between physicians and Medicare, as The Hill reports that “more than 80 percent of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue.”

This is based on a study conducted by the Harvey L. Neiman Health Policy Institute. According to the article, the study found “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.”

Those bonuses become penalties this year under healthcare reform, and Institute CEO Richard Duszak believes that only “near-term improvements in documentation and reporting” will prevent “widespread physician penalties.” He stresses that physician compliance, while showing signs of improvement over the last few years, needs to happen now, because 2015’s penalties will be determined by 2013’s performance.

The Hill’s Elise Viebeck writes, “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.”

Performing the best in the Institute’s study were radiologists, “with nearly 24 percent of imaging docs eligible for PQRS incentives that year compared to 16 percent of others.” This translates into possible 2016 penalties of $100 million for radiologists, and over $1 billion for nonradiologists.

The AMA, among others, is fighting the government over PQRS penalties, requesting that they not be enacted in 2013 and instead be delayed until 2015.

As always, we’d like to get your perspective on this issue. What is your general opinion on these penalties? Should they be enacted this year? For those of you who are gainfully employed, what have you done to qualify under PQRS or what are you improving in order to qualify?

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