Getting Ahead of the Pay-for-Performance Curve

January 14, 2011
Richard Woodcock, MD

Much of the effort in pay-for-performance programs seems cryptic to radiologists and doctors in general. For now that’s because it is not impacting our bottom line very much. That said, if you can get ahead of the curve now, you'll make things easier later when they mean more to you financially.

Much of the effort in pay for performance, CMS's new PQRI system, seems cryptic to radiologists and doctors in general. In point of fact, for now that’s because it is not impacting our bottom line very much. 

That said, if you can get ahead of the curve now, you'll make things easier later when they mean more to you financially.

Designate someone in the business office to learn about pay-for-performance programs. There are many resources for this, from CMS to the ACR to the RBMA. Have this staffer find out the most up-to-date requirements and the expected payments. Then ask that an analysis be performed, specific to your practice, to show cost and benefit for implementation.

Simultaneously have the billing office educate your billing staff on these issues. They will need to audit the relevant studies for fulfillment of criteria. Keep statistics on compliance. Check with your coding software; most can provide you with statistics about how many studies of each type actually qualify. This will give you some sense of how you are doing.

The missing link is in knowing exactly how your physicians are doing in fulfilling all requirements. Auditing a sampling of your studies and providing the data to the physicians is helpful. A few extra steps can help with compliance:

• Educate the staff on what the standards are. Create a handout that lists the standards and then post them in the reading areas on large laminated placards. Review them at regular meeting with the radiologists.

• Explain why you want or need to follow the standards. Use hard numbers to show the value. Putting dollar Information is often a powerful tool to encourage compliance.