Facility-Based Measurement in the Merit-Based Incentive Payment System: A Potential Safety Net for Which Most Radiologists Will Be Eligible
Lauren Parks Golding1, Gregory N. Nicola2, Richard Duszak, Jr.3 and Andrew B. Rosenkrantz4
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Citation: American Journal of Roentgenology: 1-5. 10.2214/AJR.19.21344
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ABSTRACT :
OBJECTIVE. The purpose of this study was to assess the percentage and characteristics of radiologists who meet criteria for facility-based measurement in the Merit-Based Incentive Payment System (MIPS).
MATERIALS AND METHODS. The Provider Utilization and Payment Data: Physician and Other Supplier Public Use File was used to identify radiologists who bill 75% or more of their Medicare Part B claims in the facility setting.
RESULTS. Among 31,217 included radiologists nationwide, 71.0% met the eligibility criteria for facility-based measurement as individuals in MIPS. The percentage of predicted eligibility was slightly higher for male than female radiologists (72.9% vs 64.5%). The percentage decreased slightly with increasing years in practice (from 78.8% for radiologists with < 10 years in practice to 67.3% for radiologists with ≥ 25 years in practice). The eligibility percentage was also higher for radiologists in rural as opposed to urban practices (81.6% vs 71.3%) and in academic as opposed to nonacademic practices (77.2% vs 70.3%). However, the percentages were similar across practices of varying sizes. There was also a greater degree of heterogeneity by state, ranging from 50.9% in Minnesota to 94.0% in West Virginia. By overall geographic region, the percentage of predicted eligibility was lowest in the Northeast (64.7%) and highest in the Midwest (78.3%). A higher percentage of generalists met the 75% facility-based threshold than did subspecialists (77.3% vs 65.4%). When stratified by subspecialty, however, facility-based eligibility was lowest for musculoskeletal radiologists (38.1%) and breast imagers (45.1%) and highest for cardiothoracic radiologists (85.1%). For other subspecialties, predicted eligibility ranged from 66.0% to 77.8%.
CONCLUSION. Most radiologists will be eligible for facility-based reporting for MIPS in 2019, with some variation by demographic and specialty characteristics. The facility-based option provides a safety net for radiologists who face challenges accessing hospital data for reporting quality measures. In general, radiologists should not alter their current MIPS strategy but should instead consider facility-based measurement as a contingency plan that could result in a higher final score.
Keywords: facility-based, health policy, MACRA, Medicare Access and CHIP Reauthorization Act, Merit-Based Incentive Payment System, MIPS, Quality Payment Program
Based on a presentation at the American College of Radiology 2019 annual meeting, Washington, DC.
Supported by research grants from the Harvey L. Neiman Health Policy Institute to R. Duszak, Jr., and A. B. Rosenkrantz.
References
Previous section
1. Medicare Access and CHIP Reauthorization Act of 2015. Pub L No. 114-10. [Google Scholar]
2. Quality Payment Program website. 2017 Quality Payment Program reporting experience. qpp.cms.gov/about/resource-library. Accessed March 20, 2019 [Google Scholar]
3. Medicare program; revisions to payment policies under the physician fee schedule and other revisions to part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program. Fed Regist 2018; 83:35704–36368 [Google Scholar]
4. Medicare program: CY 2018 updates to the Quality Payment Program. Fed Regist 2017; 82:30010–30500 [Google Scholar]
5. Rosenkrantz AB, Hoque K, Hemingway J, Hughes DR, Duszak R Jr. Unique Medicare beneficiaries served: a radiologist-focused specialty-level analysis. J Am Coll Radiol 2018; 15:734–739 [Crossref] [Medline] [Google Scholar]
6. Rosenkrantz AB, Friedberg EB, Prologo JD, Everett C, Duszak R Jr. Generalist versus subspecialist workforce characteristics of invasive procedures performed by radiologists. Radiology 2018; 289:140–147 [Crossref] [Medline] [Google Scholar]
7. Rosenkrantz AB, Wang W, Vijayasarathi A, Duszak R Jr. Physician specialty and radiologist characteristics associated with higher Medicare patient complexity. Acad Radiol 2018; 25:219–225 [Crossref] [Medline] [Google Scholar]
8. Centers for Medicare & Medicaid Services website. Medicare fee-for-service provider utilization & payment data physician and other supplier public use file. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Medicare-Physician-and-Other-Supplier-PUF-Methodology.pdf. Published April 7, 2014. Updated May 3, 2018. Accessed November 5, 2018 [Google Scholar]
9. Rosenkrantz AB, Bilal NH, Hughes DR, Duszak R Jr. National specialty trends in billable diagnostic ultrasound in the ED: analysis of Medicare claims data. Am J Emerg Med 2014; 32:1470–1475 [Crossref] [Medline] [Google Scholar]
10. Rosenkrantz AB, Nicola GN, Duszak R Jr. Characteristics of high-performing radiologists within Medicare quality programs. J Am Coll Radiol 2018; 15:842–849 [Crossref] [Medline] [Google Scholar]
11. United States Census Bureau website. Census regions and divisions of the United States. www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html. 2010. Accessed October 13, 2018 [Google Scholar]
12. Harvey L. Neiman Health Policy Institute website. Identification of academic radiology practices. www.neimanhpi.org/academic-radiology-practices/. Accessed October 13, 2018 [Google Scholar]
13. Missouri Census Data Center website. Metadata for dataset /pub/data/georef/zcta_master.mcdc.missouri.edu/data/georef/zcta_master.Metadata.html. Revised August 19, 2013. Accessed October 13, 2018 [Google Scholar]
14. Rosenkrantz AB, Wang W, Hughes DR, Ginocchio LA, Rosman DA, Duszak R Jr. Academic radiologist subspecialty identification using a novel claims-based classification system. AJR 2017; 208:1249–1255 [Abstract] [Google Scholar]
15. Rosenkrantz AB, Wang W, Bodapati S, Hughes DR, Duszak R Jr. Private practice radiologist subspecialty classification using Medicare claims. J Am Coll Radiol 2017; 14:1419–1425 [Crossref] [Medline] [Google Scholar]
16. Medscape website. Medscape radiologist compensation report 2018. www.medscape.com/slideshow/2018-compensation-radiologist-6009673. Published April 18, 2018. Accessed December 1, 2018 [Google Scholar]
17. Centers for Medicare & Medicaid Services website. Hospital Outpatient Quality Reporting Program. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalOutpatientQualityReportingProgram.html. Last modified January 11, 2018. Accessed December 1, 2018 [Google Scholar]
18. Flug JA, Hemingway J, Hughes D, Silva E 3rd, Duszak R Jr. Medicare policy initiatives and the relative utilization of “double-scan” CT. J Am Coll Radiol 2016; 13:137–143 [Crossref] [Medline] [Google Scholar]
19. Centers for Medicare & Medicaid Services website. Physician Quality Reporting System (PQRS) overview. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf. Accessed December 1, 2018 [Google Scholar]
20. Duszak R Jr, Saunders WM. Medicare's physician quality reporting initiative: incentives, physician work, and perceived impact on patient care. J Am Coll Radiol 2010; 7:419–424 [Crossref] [Medline] [Google Scholar]
21. Duszak R Jr, Burleson J, Seidenwurm D, Silva E 3rd. Medicare's Physician Quality Reporting System: early national radiologist experience and near-future performance projections. J Am Coll Radiol 2013; 10:114–121 [Crossref] [Medline] [Google Scholar]
Address correspondence to L. P. Golding (laurengoldingmd@gmail.com).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21344
Lauren Parks Golding1, Gregory N. Nicola2, Richard Duszak, Jr.3 and Andrew B. Rosenkrantz4
Share Share
+ Affiliations:
Citation: American Journal of Roentgenology: 1-5. 10.2214/AJR.19.21344
AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The purpose of this study was to assess the percentage and characteristics of radiologists who meet criteria for facility-based measurement in the Merit-Based Incentive Payment System (MIPS).
MATERIALS AND METHODS. The Provider Utilization and Payment Data: Physician and Other Supplier Public Use File was used to identify radiologists who bill 75% or more of their Medicare Part B claims in the facility setting.
RESULTS. Among 31,217 included radiologists nationwide, 71.0% met the eligibility criteria for facility-based measurement as individuals in MIPS. The percentage of predicted eligibility was slightly higher for male than female radiologists (72.9% vs 64.5%). The percentage decreased slightly with increasing years in practice (from 78.8% for radiologists with < 10 years in practice to 67.3% for radiologists with ≥ 25 years in practice). The eligibility percentage was also higher for radiologists in rural as opposed to urban practices (81.6% vs 71.3%) and in academic as opposed to nonacademic practices (77.2% vs 70.3%). However, the percentages were similar across practices of varying sizes. There was also a greater degree of heterogeneity by state, ranging from 50.9% in Minnesota to 94.0% in West Virginia. By overall geographic region, the percentage of predicted eligibility was lowest in the Northeast (64.7%) and highest in the Midwest (78.3%). A higher percentage of generalists met the 75% facility-based threshold than did subspecialists (77.3% vs 65.4%). When stratified by subspecialty, however, facility-based eligibility was lowest for musculoskeletal radiologists (38.1%) and breast imagers (45.1%) and highest for cardiothoracic radiologists (85.1%). For other subspecialties, predicted eligibility ranged from 66.0% to 77.8%.
CONCLUSION. Most radiologists will be eligible for facility-based reporting for MIPS in 2019, with some variation by demographic and specialty characteristics. The facility-based option provides a safety net for radiologists who face challenges accessing hospital data for reporting quality measures. In general, radiologists should not alter their current MIPS strategy but should instead consider facility-based measurement as a contingency plan that could result in a higher final score.
Keywords: facility-based, health policy, MACRA, Medicare Access and CHIP Reauthorization Act, Merit-Based Incentive Payment System, MIPS, Quality Payment Program
Based on a presentation at the American College of Radiology 2019 annual meeting, Washington, DC.
Supported by research grants from the Harvey L. Neiman Health Policy Institute to R. Duszak, Jr., and A. B. Rosenkrantz.
References
Previous section
1. Medicare Access and CHIP Reauthorization Act of 2015. Pub L No. 114-10. [Google Scholar]
2. Quality Payment Program website. 2017 Quality Payment Program reporting experience. qpp.cms.gov/about/resource-library. Accessed March 20, 2019 [Google Scholar]
3. Medicare program; revisions to payment policies under the physician fee schedule and other revisions to part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program. Fed Regist 2018; 83:35704–36368 [Google Scholar]
4. Medicare program: CY 2018 updates to the Quality Payment Program. Fed Regist 2017; 82:30010–30500 [Google Scholar]
5. Rosenkrantz AB, Hoque K, Hemingway J, Hughes DR, Duszak R Jr. Unique Medicare beneficiaries served: a radiologist-focused specialty-level analysis. J Am Coll Radiol 2018; 15:734–739 [Crossref] [Medline] [Google Scholar]
6. Rosenkrantz AB, Friedberg EB, Prologo JD, Everett C, Duszak R Jr. Generalist versus subspecialist workforce characteristics of invasive procedures performed by radiologists. Radiology 2018; 289:140–147 [Crossref] [Medline] [Google Scholar]
7. Rosenkrantz AB, Wang W, Vijayasarathi A, Duszak R Jr. Physician specialty and radiologist characteristics associated with higher Medicare patient complexity. Acad Radiol 2018; 25:219–225 [Crossref] [Medline] [Google Scholar]
8. Centers for Medicare & Medicaid Services website. Medicare fee-for-service provider utilization & payment data physician and other supplier public use file. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Medicare-Physician-and-Other-Supplier-PUF-Methodology.pdf. Published April 7, 2014. Updated May 3, 2018. Accessed November 5, 2018 [Google Scholar]
9. Rosenkrantz AB, Bilal NH, Hughes DR, Duszak R Jr. National specialty trends in billable diagnostic ultrasound in the ED: analysis of Medicare claims data. Am J Emerg Med 2014; 32:1470–1475 [Crossref] [Medline] [Google Scholar]
10. Rosenkrantz AB, Nicola GN, Duszak R Jr. Characteristics of high-performing radiologists within Medicare quality programs. J Am Coll Radiol 2018; 15:842–849 [Crossref] [Medline] [Google Scholar]
11. United States Census Bureau website. Census regions and divisions of the United States. www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html. 2010. Accessed October 13, 2018 [Google Scholar]
12. Harvey L. Neiman Health Policy Institute website. Identification of academic radiology practices. www.neimanhpi.org/academic-radiology-practices/. Accessed October 13, 2018 [Google Scholar]
13. Missouri Census Data Center website. Metadata for dataset /pub/data/georef/zcta_master.mcdc.missouri.edu/data/georef/zcta_master.Metadata.html. Revised August 19, 2013. Accessed October 13, 2018 [Google Scholar]
14. Rosenkrantz AB, Wang W, Hughes DR, Ginocchio LA, Rosman DA, Duszak R Jr. Academic radiologist subspecialty identification using a novel claims-based classification system. AJR 2017; 208:1249–1255 [Abstract] [Google Scholar]
15. Rosenkrantz AB, Wang W, Bodapati S, Hughes DR, Duszak R Jr. Private practice radiologist subspecialty classification using Medicare claims. J Am Coll Radiol 2017; 14:1419–1425 [Crossref] [Medline] [Google Scholar]
16. Medscape website. Medscape radiologist compensation report 2018. www.medscape.com/slideshow/2018-compensation-radiologist-6009673. Published April 18, 2018. Accessed December 1, 2018 [Google Scholar]
17. Centers for Medicare & Medicaid Services website. Hospital Outpatient Quality Reporting Program. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalOutpatientQualityReportingProgram.html. Last modified January 11, 2018. Accessed December 1, 2018 [Google Scholar]
18. Flug JA, Hemingway J, Hughes D, Silva E 3rd, Duszak R Jr. Medicare policy initiatives and the relative utilization of “double-scan” CT. J Am Coll Radiol 2016; 13:137–143 [Crossref] [Medline] [Google Scholar]
19. Centers for Medicare & Medicaid Services website. Physician Quality Reporting System (PQRS) overview. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf. Accessed December 1, 2018 [Google Scholar]
20. Duszak R Jr, Saunders WM. Medicare's physician quality reporting initiative: incentives, physician work, and perceived impact on patient care. J Am Coll Radiol 2010; 7:419–424 [Crossref] [Medline] [Google Scholar]
21. Duszak R Jr, Burleson J, Seidenwurm D, Silva E 3rd. Medicare's Physician Quality Reporting System: early national radiologist experience and near-future performance projections. J Am Coll Radiol 2013; 10:114–121 [Crossref] [Medline] [Google Scholar]
Address correspondence to L. P. Golding (laurengoldingmd@gmail.com).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21344
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