Cheryl Proval

After waxing sentimental in this space over the new CMS quality measures for radiology, I took a preliminary survey of some of the best-run back offices in radiology, and made a surprising discovery. I found only one practice that is actively participating—more about that later—and therefore potentially eligible for the performance bonus in 2007.


Because the measures are so complex, anyone doing their own billing would have to hire a software engineer to write the code to make compliance possible, unlikely to happen as radiology gets the squeeze on all fronts and many private practice radiologists prepare to take a pay cut in 2007. And rumors run rampant in the absence of communications.

Time for a reality check. Where did these measures come from anyway?

For an answer, I went to David Seidenwurm, MD, a radiologist practicing with the Radiological Associates of Sacramento in California, who co-authored an article in the September issue of the American Journal of Neuroradiology that provides clinical guidance on the measures.

Seidenwurm was a cochair of the stroke and stroke rehabilitation workgroup of the Physician’s Consortium for Performance Improvement (PCPI), which wrote the clinical part of the performance measures for stroke and stroke rehabilitation relevant to stroke imaging, ultimately adopted by CMS as part of the Physician Quality Reporting Initiative (PQRI) program for 2007. He has also been a cochair of the radiology workgroup that is currently in the final stages of writing some performance measures for radiology as a whole.

According to Seidenwurm, CMS adopted the stroke measures for imaging, as well as a number of other complementary stroke measures that apply to other specialties, from a set of performance measures developed through the PCPI. The PCPI participants include the American Medical Association and more than 100 medical specialty organizations and state medical societies that have been working on rigorous, scientific performance measures for physicians well in advance of PQRI. “The idea is to try to translate the results from the best scientific investigations and the most widely accepted clinical guidelines into specific actionable, specifiable performance measures that are directly attributable to the actions of particular doctors,” he said.

Seidenwurm explains that the measures were tweaked slightly for the PQRI purpose to enable the clinical measures to be implemented as an administrative activity involving the linking of the relevant ICD-9 and the CPT codes. “And frankly, the challenge in the radiology field is actually quite a bit smaller than the challenge in some other clinical fields,” he noted. “Many radiologists use electronic claims submission, a lot of radiologists use computerized billing systems, computerized RIS-type products, but adapting their use to how Medicare thinks of the coding and billing is perhaps a nontrivial task.”

Second question: If practices invest the time and money in complying with these measures, will there be any financial incentive next year?

“The measures will be around; whether they’ll be around as part of Medicare is above my pay grade,” Seidenwurm demurred, but he did add that he uses the measures in his personal practice. He expects the brain MRI and CT measure to stay exactly the same in 2008, but reports that the carotid imaging measure will be made more general, so that it does not apply only to the setting of acute stroke or TIA, somewhat easing the administrative implementation of this measure. New measures pertaining to mammography and radiation dose are posted on the ACR web site awaiting comment.

Seidenwurm remains upbeat about the measures, and reports that he is using them in his personal clinical practice, in order to monitor quality. “Nationally, about half of recommended care gets delivered,” observed Seidenwurm, citing the 2003 paper published in the New England Journal of Medicine.

Back to the single (known) PQRI-participating radiology practice in America, Mid-South Imaging and Therapeutics, PA, Memphis, Tenn. The practice’s chief administrative officer, Worth M. Saunders, MHA, offered assurance that other practices are participating or planning to, based on his attendance at a roundtable discussion held at the fall meeting of the Radiology Business Management Association.

The practice outsources billing, and its billing vendor, McKesson’s Per-Sé, is handling the administrative details. The practice’s 37 radiologists are doing their part, willingly. Saunders is uncertain whether the practice will qualify for the 1.5% bonus, and he will not hear from CMS on that until next year. Nonetheless, the initial “P” in P4P was not the incentive for the practice to participate. Even if it does ultimately receive the 1.5% bonus, Saunders does not believe the cost of implementing the program will be offset.

“If you look at it as a financial return on investment, it was really a decision on our part to make the investment, since P4P will be the wave of the future,” Saunders revealed. “That was the main driver from our perspective: we didn’t look at it from the financial perspective.”

Mid-South Imaging and Therapeu-tics, and all of the other practices that are participating in this now-voluntary PQRI program, deserve commendation for their investment in quality. Nonetheless, it must be noted that the party favor at the CMS P4P party is a bag full of irony.

Cheryl Proval is business editor for Axis Imaging News. For more information, contact