Changes to Medicare’s quality payment program may disadvantage radiologists
Recent changes to Medicare’s quality payment programs may disadvantage diagnostic radiologists, according to new research published Tuesday.
CMS first introduced the Merit-based Incentive Payment System in 2017, seeking to link physician reimbursement to performance. Under MIPS, providers receive a composite final score that determines an upward, neutral or downward adjustment to their payments.
However, CMS is now moving to new MIPS Value Pathways, or MVPs, which are specialty-specific measures intended to replace traditional ones, experts write in JACR. This is slated to begin with the 2026 performance year, with multispecialty doc groups now losing access to radiology-specific measures.
An analysis of 2023 data from the MIPS program shows this transition is likely to further hinder radiologists, warranting attention from imaging leaders.
“Radiologists' MIPS performance [has] depended on multispecialty group reporting of nonradiology measures, a strategy MVPs will largely eliminate,” writes Rebecca Smith-Bindman, MD, a professor with the University of California, San Francisco, and co-founder and CMO of Alara Imaging, a company that helps health systems with radiology measure compliance. “Modeled estimates suggest [the new measure focused on excessive radiation dosing], the sole outcome measure in the 2026 diagnostic radiology MVP, could partially offset this loss.”
To back their claims, Smith-Bindman and co-author Carly Stewart, also with Alara, analyzed diagnostics rads’ MIPS performance for a single year. They identified structural factors affecting payment adjustments and estimated the potential impact of the new “ExRad” quality measure (Q494). Their cross-sectional analysis of publicly available MIPS data included nearly 250,000 physicians and 25,000 diagnostic rads. Twenty radiology measures were assessed for “topped-out status”—meaning a measure has achieved such uniformly high performance that it is no longer effective. The authors then used a simulation to replace each radiology-only reporter’s lowest scoring measure with ExRad at scores of 5, 7 and 9.
Based on their study, radiologists ranked 28th out of 62 specialties in average payment adjustment (at +0.39% versus +0.2%). Mixed reporters (40.1%) had the highest quality score (85.1/100) and payment adjustment (+0.9%; 9.8% penalized). Radiology-only MIPS reporters (15.8%) had the lowest among measure reporters (quality score 71.4/100; +0.14%; 27.3% penalized). Six of the 20 radiology measures were topped-out in 2023, and the most reported ones averaged 5.7 to 8.3 among radiology-only reporters. Among individually reporting rads, 87.3% reported no measures (average adjustment -1.99%).
In the simulation, ExRad substitution increased estimated adjustments by 0.15 to 0.45 percentage points. At a score of 9, about 40% of penalized radiology-only reporters avoided negative adjustments. The authors noted that 68.1% of diagnostic radiologists reported nonradiology quality measures through multispecialty groups. Beginning with the 2026 performance year, MVP rules will restrict this group level reporting, “effectively converting most radiologists to radiology-only reporting and removing access to higher scoring nonradiology measures.”
“Practices should use the transition period, during which traditional MIPS and subgroup MVP reporting can run in parallel, to develop the reporting and CT dose optimization infrastructure that MVP participation will require,” Smith-Bindman and Stewart advised.
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.