Small practices, individual radiologists at a disadvantage in Medicare quality pay program

Small imaging groups and individual radiologists still appear to be at a disadvantage in a key quality payment program, according to new research published Monday. 

The Merit-Based Incentive Payment System (MIPS) was established in 2017 to reward physician performance and help reduce healthcare costs. However, radiologists have faced challenges in the alternative pay model, as the specialty often does not interact directly with patients and there are relatively few imaging-related metrics. 

Neiman Health Policy Institute researchers aimed to better understand the factors influencing physician success in MIPS, sharing their findings Wednesday in the Journal of the American College of Radiology. They noted that radiologists using individual reporting and those affiliated with smaller practices were less likely to attain “exceptional” performance bonus status in the federal program.

“Despite CMS’ efforts to support smaller-practice MIPS success with bonus points and reduced reporting requirements, smaller practices remain disadvantaged,” lead author YoonKyung Chung, PhD, principal economic and health services researcher at the Neiman Institute, which is part of the ACR, said in a statement Feb. 26. “Yet, evidence does not support that smaller practices provide lower quality care.”

The study covered 2019 MIPS performance data, altogether incorporating nearly 23,000 radiology participants. About 75% of the sample took part in the program through group reporting, while 4% did so as individual radiologists. Another nearly 21% did so as MIPS Advanced Payment Model entities—allowing them to receive additional benefits or avoid penalties based on their performance in this specific APM. 

On average, radiologist participants logged a score of 88.8 on a 100-point scale, the study found. Over 88% reached “exceptional” status and were able to score the related performance bonus. Those participating as Advanced Payment Model entities had a roughly 7.2-point higher average MIPS score than those using group reporting. Individual reporters, meanwhile, notched an average score about 28.3 points lower than others. Chung and co-authors also noted that radiologists in groups with more than 500 clinicians had a 10.3-point higher score than peers participating in practices with 10 or fewer physicians. Individual radiologists and those in smaller practices also were less likely to achieve “exceptional” performance. Amid these challenges, the proportion of rads participating through individual reporting fell from 17% in 2017 down to 4% two years later. 

None of the measures used by radiologists in the Advanced Payment Model were relevant to the specialty, due to separate reporting requirements, the authors noted. This comes after another 2024 Neiman study found that there are too few measures available for members of the specialty. 

“Unfortunately, the imbalance in available MIPS radiology measures is worsening,” study co-author Lauren Nicola, MD, CEO of Triad Radiology Associates in Winston Salem, North Carolina, said in the announcement. “None of the top 10 quality measures reported by individual and group participants in our analysis were still available for full score potential in 2024. It is unsurprising that radiologists reporting in groups or APMs take advantage of the opportunity to report measures of other medical specialties within their practice.”

Experts believe Medicare must do more to provide an even playing field for all physicians and practice types participating in the program. 

“Together, these results suggest systemic bias in the MIPS program and unequal opportunity to attain top scores among practicing radiologists and provides important data to inform future program design that may reduce bias and better achieve the goal of incentivizing higher value care,” the authors concluded.