Medicare P4P falling short on bonuses

Medicare’s pay-for-performance (P4P) program, the Physician Quality Reporting Initiative (PQRI), is falling short on bonus payments, according to a study in the Journal of the American College of Radiology.

Not only that, but “There’s very little transparency in the process,” says lead author Richard Duszak Jr., MD, a radiologist at Mid-South Imaging & Therapeutics in Memphis.

His medical group participated in educational programs to get ready for the PQRI initiatives, but was only paid an extra 0.36 percent of the total Medicare payment, well under the expected Medicare bonus of 1.5 percent. As a percentage of collections from all payers, PQRI bonuses amounted to just 0.11 percent, well below the estimated 1.5 percent mean increase in overall physician work necessary for participation.

After conducting its own internal audit, the medical group found that “there are still a large number of cases where we’ve reviewed our own documentation and we’ve met every requirement that Medicare has put forth, but for reasons unclear to us because of the black box of bureaucracy, we can’t get our bonus,” Duszak says. “There isn’t a mechanism to find out why.”

Despite the small bonuses, the physicians did change their behavior, says Duszak, and that is something that might be useful for health plans to note. “What we don’t know is how durable that change in behavior is.”

In general, PQRI payments are doled out only after provider groups conform to rigid documentation, reporting, and coding requirements. “If payers really want to move forward down the path of value-based purchasing, then they need to develop legitimate metrics — not just dot your ‘i’s and cross your ‘t’s — really develop metrics that physicians in the trenches perceive as being valuable.”

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