Mid-South Imaging and Therapeutics, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee 38120, USA.
J Am Coll Radiol. 2010 Jun;7(6):419-24. doi: 10.1016/j.jacr.2009.12.011.
The aims of this study were to compare incremental radiologist work to incremental financial incentives under Medicare's Physician Quality Reporting Initiative (PQRI) and to evaluate physicians' perceptions of the program's impact on the quality of care.
Medicare PQRI bonus information was acquired for 29 radiologists from a single practice over the program's first two cycles. Incremental bonus incentive percentages were calculated using total payments from Medicare and from all payers. Physicians were surveyed regarding incremental time required to participate and their perceptions of the program's impact on the quality of delivered care. Incentive data and survey results were analyzed and compared.
Despite ongoing educational and operational initiatives, mean physician Medicare PQRI incentives amounted to only 0.36% of total practice Medicare payment, well under Medicare's expected bonus of 1.5%. As a percentage of collections from all payers, PQRI bonuses amounted to just 0.11%, well less than the estimated 1.5% mean increase in overall physician work necessary for participation. Only 10 (34%) and 6 (21%) radiologists received bonuses each cycle, respectively, and only 1 (3%) achieved bonuses for both cycles. Most physicians (76%) perceived that PQRI participation in no way improved the quality of radiologic services delivered.
Even when aggressively pursued, Medicare's pay-for-performance program, PQRI, yields actual physician bonuses far less than those expected, more than an order of magnitude less than requisite incremental radiologist work, with little reported impact on quality. For such programs to engender ongoing physician participation, fundamental changes will be necessary to address discordantly low incentives and perceived lack of benefit to patient care.
本研究旨在比较在 Medicare 的医师质量报告倡议（PQRI）下，放射科医生的增量工作与增量经济激励的差异，并评估医生对该计划对医疗质量影响的看法。
从一个单一的实践中获取了 29 名放射科医生在计划的前两个周期中的 Medicare PQRI 奖金信息。使用 Medicare 和所有支付者的总支付额计算增量奖金激励百分比。对医生参与所需的增量时间以及他们对计划对提供的医疗质量的影响的看法进行了调查。对激励数据和调查结果进行了分析和比较。
尽管进行了持续的教育和运营计划，医生的 Medicare PQRI 激励平均仅占总实践 Medicare 支付的 0.36%，远低于 Medicare 预期的 1.5%奖金。作为所有支付者的收入的百分比，PQRI 奖金仅为 0.11%，远低于参与所需的医生总工作量的估计 1.5%的增长。每个周期分别只有 10 名（34%）和 6 名（21%）放射科医生获得了奖金，只有 1 名（3%）获得了两个周期的奖金。大多数医生（76%）认为 PQRI 参与没有改善放射服务的质量。
即使积极追求，Medicare 的基于绩效的计划 PQRI 也只会产生远远低于预期的实际医生奖金，比所需的增量放射科医生工作少一个数量级，而且报告的对质量的影响很小。为了使这些计划能够持续吸引医生参与，需要进行根本性的变革，以解决激励措施明显不足和对患者护理的益处缺乏认知的问题。
