We all know that health care reform is flipping the fee-for-service model on its head and ultimately moving us from a volume-based to a value-based health care system. Significant parts of President Obama's 2010 law focus on rewarding quality health care, with the overall goal of hopefully saving us billions in health care costs. While you may have heard about how hospitals are taking the brunt of such penalties (i.e. a Medicare reimbursement reduction for excess readmissions that link Medicare payments to the quality of care that hospitals provide), Medicare doctors are also being held responsible for quality in the care they provide.

Without changes to the way doctors report quality measures to the Medicare Physician Quality Reporting System program -- a 6-year-old program set-up to incentivize physicians with bonuses when they meet specific quality reporting requirements -- more than 75 percent of radiologists could face average penalties of at least $2,654 in 2016, totaling roughly $100 million for the entire profession. That's according to a recent study from the new American College of Radiology's Harvey L. Neiman Health Policy Institute, which also found that doctors besides radiologists should expect penalties of over $1 billion by 2016.

"Because it's physician reporting behavior in 2013 that will be used as the basis for penalties in 2015, we now have about 365 days to get our collective act together so that we -- physicians in general -- won't be subject to widespread government penalties," Dr. Richard Duszak, chief executive officer and senior research fellow of the Harvey L. Neiman Health Policy Institute, told DOTmed News for an article we published on Jan. 8 about the study.

In other words, it's time to pay attention to how the game is changing -- and to how the Centers for Medicare and Medicaid Services is tweaking the rules.

The American Medical Association reacted on Monday adding that 2013 is in fact the first Medicare quality reporting year that involves a possible penalty.

Dr. Patrick Conway, director of the Center for Clinical Standards and Quality at CMS, told amednews that "a physician or group of physicians that attempts to report PQRS measures in 2013 but does not meet the criteria for a bonus still will not have pay rates downgraded in 2015... CMS adopted this policy because 2013 is the first reporting year that involves a possible penalty."

About 30 percent of eligible professionals submitted at least some PQRS data in 2011, according to preliminary data, the article stated.

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