MACRA ‘wake-up call’ rung for radiology

If the past predicts the future, then radiology isn’t going to fare especially well in the MACRA era. Under Medicare’s last pay-for-reporting program, the Physician Quality and Reporting System (PQRS), most radiologists only minimally showed their work, researchers have found. Those who deal the same way with MACRA—the Medicare Access and CHIP Reauthorization Act—are setting themselves up for punitive payment adjustments, the study authors warn in an article published online Oct. 26 in the Journal of the American College of Radiology.

MACRA currently affects reimbursement adjustments by calculating performance rates for a minimum of six measures, note NYU Langone researchers Luke Ginocchio, MD, Andrew Rosenkrantz, MD, and colleagues in introducing their findings.

With co-authors Richard Duszak Jr., MD, of Emory University and Gregory Nicola, MD, chair of ACR’s MACRA committee, they searched for Medicare-participating radiologists in the agency’s Physician Compare online database.

The team’s objective was to use the frequency with which randomly selected radiologists reported PQRS measures as a marker of the profession’s preparedness for MACRA.

Once the researchers had 1,000 radiologists who reported at least one PQRS measure, they explored associations between the number of reported measures and radiologist characteristics.

They found that more than half the cohort reported just one or two PQRS measures (25.2 percent and 27.3 percent, respectively).

A respectable 18.2 percent and 19.3 percent reported three and four measures, respectively.

However, only 8.3 percent reported five measures and just 1.7 percent reported six.

The most commonly reported measures were “documenting radiation exposure time for procedures using fluoroscopy” (64.3 percent) and “accurate measurement of carotid artery narrowing” (56.8 percent), the authors report.

The team further found that reporting six measures was significantly more likely for generalists (2.6 percent) versus subspecialists (0.4 percent).

Additionally, reporting at least two measures was significantly more likely for nonacademic (77.3 percent) versus academic (44.9 percent) radiologists, generalists (82.7 percent) versus subspecialists (59.1 percent), and radiologists in smaller (nine or fewer members) (84.7 percent) versus larger (100 or more members) (39.7 percent) practices.

“Most PQRS-reporting radiologists reported only one or two measures, well below MACRA’s requirement of six,” Ginocchio et al. comment. “Radiologists continuing such reporting levels will likely be disadvantaged in terms of potential payment adjustments under MACRA.”

The authors suggest that the lower reporting rates for academic, subspecialized and large-practice radiologists may reflect these rads’ reliance on their hospitals for PQRS reporting.

“Qualified clinical data registries should be embraced to facilitate more robust measure reporting,” they write.