How to Finish your ABR PQI Requirement and Increase your Reimbursement Rate

March 1, 2019

At first blush, the MOC Part 4 requirement — the Participatory Quality Improvement (PQI) Project — looks like soul-crushing drivel. My core philosophy is that life is way too short for busywork. So I set out this month to find the minimum acceptable activity that would satisfy the PQI requirement, and what I discovered surprised me.

If your group follows these three steps to execute the ABR PQI correctly, you’ll also unlock higher reimbursement rates, knock out your CME, and make your group’s radiologists smarter and more fulfilled. Forward this post to your group’s administrative leadership so they can follow up — you shouldn’t have to struggle with this alone. Feel free to have them contact me for help as needed.

1. Make sure your PQI project would survive an ABR audit

To give you flexibility, the American Board of Radiology defines a PQI project broadly as “a systematic approach to the study of healthcare and/or a commitment to continuously improve performance and outcomes in healthcare.” Here’s a list of PQI projects suggested by the ABR. What’s the minimum you could do to satisfy the ABR PQI audit? Hint: Just signing into tumor board won’t cut it. But here are two write-ups that would pass. Feel free to copy-paste and implement either of these options.

The PQI audit write-up is basically just a research abstract with a performance metric, suggested contributing factors, an intervention, and a before/after graph to show the effect of the intervention. By the way, your PQI doesn’t need to work — it just needs to follow this format.

2. Have your group structure the PQI so that your team can increase reimbursement

It turns out that by crafting your PQI project carefully, your group can drive higher Medicare reimbursements. But not all PQI projects qualify.

For context, back in 2015, the government passed a law called the Medicare Access and CHIP Reauthorization Act (MACRA), which revised the equation that determines how much we’re reimbursed for our studies by Medicare. Under MACRA, your reimbursement can be penalized up to 9 percent or increased 10 percent depending on metrics that try to relate to your quality of care.

One of the key ways in which you can now modulate your reimbursement is by engaging in “Improvement Activities” designated by the Quality Payment Program (QPP) each year. Here’s a link to all eligible Improvement Activities for 2019.

What’s amazing is that your ABR PQI can serve as a QPP Improvement Activity if you structure it correctly. For this purpose, it helps if your PQI is:

All of this information on how to repurpose your PQI for increased reimbursement is documented on the QPP site here but the site is flooded with information, most of which doesn’t relate to radiology. Ask your group’s administrative leadership to look at this.

Orbit helps restore work-life balance by awarding CME and CE for the internet-based learning that doctors, PAs and nurses already perform while caring for patients.

3. Design your PQI to make your radiologists more fulfilled

It’s easy to design a PQI that sucks the soul from the radiologists in your group. Please don’t do that. Instead, think about a performance metric that’s aligned with growing the individual underlying skills, talent, and passions of your radiologists. If you care about the radiologists in your group, that core value should shine through in the care you take when designing your group’s PQI project.

For example, be thoughtful about how you implement a TAT-based PQI. A general TAT score ignores accuracy or case complexity. This could be perfectly fine if you have a small group of general radiologists who rotate evenly across the available rotations in your practice. For larger groups with specialty radiologists, segment your TAT scores by study type and by rotation assignment. This way, radiologists can compare themselves against others working on the same exact case mix. This extra effort will make for a more humane PQI experience.

The PQI module in Orbit Enterprise is just one example of many truly inspirational PQI projects you could deploy in your group. This activity inherently enriches and strengthens all of your group’s radiologists by making them aware of critical practice-modifying recommendations as they come out, and it rewards them with CME including self-assessment credits for engaging with the peer-reviewed literature. Engaging in this type of PQI is also good for MACRA reimbursement, the satisfaction of your radiologists, and the health of your patients.

Bottom Line. With creativity, you can design a PQI project that satisfies ABR requirements, and increases your reimbursement through QPP, qualifies for CME, inspires and delights your team, and most importantly, improves quality of care for your patients.


Ram Srinivasan, MD, PhD, is an engineer and board-certified neuroradiologist in Palo Alto, California, with a passion for simplifying lives through education technology. He’s also course director at Core Physics Review, which teaches clinically-relevant radiology physics to more than 300 residents from more than 30 residency programs. Most recently, Ram launched Orbit Radiology to help combat burnout by streamlining the process of satisfying annual CME requirements, which also offers enterprise QPP support (MACRA/MIPS) for radiology groups.

Orbit’s mission is to invest in the wellness of medical professionals.

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