Diagnostic Radiology Performance in MIPS: Dependence on Nonradiology Quality Measures and Implications of the Mandatory Transition to MIPS Value Pathways.

BACKGROUND

Medicare adjusts radiologists' reimbursement under the Merit-Basetd Incentive Payment System (MIPS); CMS plans a mandatory transition to MIPS Value Pathways (MVPs), which restrict multispecialty group-level reporting.

OBJECTIVE

To analyze 2023 MIPS performance for diagnostic radiologists, identify structural factors affecting payment adjustments, and estimate the potential impact of the ExRad quality measure (Q494).

METHODS

Cross-sectional analysis of publicly available 2023 MIPS data for 249,848 physicians, including 25,160 diagnostic radiologists. Radiologists were classified by reporting pattern (mixed, nonradiology only, radiology only, no measures) and by group versus individual reporting. Twenty radiology measures were assessed for topped-out status. A simulation replaced each radiology-only reporter's lowest scoring measure with ExRad at scores of 5, 7, and 9.

RESULTS

Radiologists ranked 28th of 62 specialties in mean payment adjustment (+0.39% versus +0.20%). Mixed reporters (40.1%) had the highest quality score (85.1) and adjustment (+0.90%; 9.8% penalized); radiology-only reporters (15.8%) had the lowest among measure reporters (quality score 71.4; +0.14%; 27.3% penalized). Six of 20 radiology measures were topped out in 2023, and the most frequently reported measures averaged 5.7 to 8.3 among radiology-only reporters. Among individually reporting radiologists, 87.3% reported no measures (mean adjustment -1.99%). In simulation, ExRad substitution increased estimated adjustments by 0.15 to 0.45 percentage points; at a score of 9, 40.0% of penalized radiology-only reporters avoided negative adjustments.

CONCLUSION

Radiologists' MIPS performance depended on multispecialty group reporting of nonradiology measures, a strategy MVPs will largely eliminate. Modeled estimates suggest ExRad, the sole outcome measure in the 2026 diagnostic radiology MVP, could partially offset this loss.