Study: Most Medicare docs set to face performance penalties

More than 80 percent of Medicare providers will face penalties for failing to meet quality thresholds if current performance trends continue, according to a new study.

The Harvey L. Neiman Health Policy Institute found Tuesday 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.

This point spells trouble for Medicare providers as the bonus program is converted to penalties for failing to meet PQRS requirements this year, researchers wrote. 

The change comes as part of President Obama's signature healthcare law.

"Near-term improvements in documentation and reporting are necessary to avert widespread physician penalties," said Richard Duszak, CEO of the Harvey L. Neiman Health Policy Institute, in a statement.

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

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.

The new study found that U.S. radiologists performed better than other Medicare providers in 2010, with nearly 24 percent of imaging docs eligible for PQRS incentives that year compared to 16 percent of others.

"As it stands, in 2016, radiologists collectively may face penalties totaling more than $100 million. Although not a specific part of this analysis, penalties for nonradiologists could total well over $1 billion," Duszak said.

Doctor groups like the American Medical Association have urged federal health officials not to implement the PQRS penalties for 2013. The fines would be levied in 2015.

Last year, most Medicare doctors who were eligible for quality bonuses did not participate in the incentive program at all.

Tuesday's study was published online in the Journal of the American College of Radiology.

The Harvey L. Neiman Health Policy Institute studies issues relevant to that field.

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