Physician Quality Reporting Initiative: Questions and Answers for Psychologists
by Government Relations Staff
Q. What is the Physician Quality Reporting Initiative (PQRI)?
A. PQRI is a voluntary reporting program that provides a financial incentive for certain health care professionals, including psychologists, who participate in Medicare to submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS).
Q. Is this a pay-for-performance program?
A. No. Pay for performance involves realigning incentives in the delivery of healthcare services to reward quality improvement. The PQRI will allow health care professionals to earn bonus payments just for reporting on the program's measures, regardless of the treatment outcomes.
Q. The program has "physician" in the title, so how can psychologists participate?
A. Under the terms of the legislation that created the PQRI a number of different health care professionals, including psychologists, are eligible for the program.
Q. What do I stand to gain from participating?
A. Health care professionals who successfully report on 80 percent of the applicable cases for any given measure will be eligible for a bonus payment equal to 2.0 percent of their total allowed Medicare charges for the reporting period. That's 2.0 percent extra for all of the claims Medicare pays you for, not just the ones you report on.
This is an increase from the 1.5 percent bonus payments for 2007 and 2008. You will also receive confidential feedback reports from CMS.
Q. So I will receive an extra 2.0 percent whenever I'm paid for a Medicare claim?
A. It doesn't happen that fast. All claims have to be filed before CMS calculates the bonus payments. Since the deadline for 2008 claims is February 28, 2009, the agency will be issuing the bonus payments for 2008 in mid-2009.
Q. How much work will it take to report the measures?
A. Reporting for the PQRI is intended not to be complicated or time-consuming. You will add a few codes to the electronic or paper claim form that you currently submit to Medicare. More detailed information is available on the CMS Web site at www.cms.hhs.gov/pqri under the category of Educational Resources. Information is also available from your local Medicare carrier.
Q. Do the measures reflect the services I provide to Medicare beneficiaries?
A. During the initial reporting period that started on July 1, 2007, psychologists had limited opportunity to participate in the PQRI, as there was only one measure for mental health. The 2007 measure focused on patients suffering from major depressive disorder that had been prescribed, or at least evaluated for, the use of antidepressant medication. Several new measures have since been developed. In 2009, psychologists will have these seven measures available for reporting:
• Major depressive disorder: antidepressant medication during acute phase for patients with MDD (#9)
• Major depressive disorder: diagnostic evaluation (#106)
• Major depressive disorder: suicide risk assessment (#107)
• Documentation and verification of current medications in the medical record (#130)
• Pain assessment prior to initiation of patient treatment (#131)
• Screening for clinical depression (#134)
• Elder maltreatment screen and follow-up plan (new measure effective in 2009)
Q. Measure #9 involves reporting on patients who are suffering from major depressive disorder and have been prescribed, or at least evaluated for, the use of antidepressant medication. How can psychologists who lack the authority to prescribe report on a measure that involves medication?
A. This measure is not limited to only the health care professional who prescribed the antidepressant medication. If you are providing psychotherapy to a patient who suffers from depression and is taking antidepressant medication prescribed by a physician, you can report the measure.
Q. What requirements do I have to meet to participate?
A. You must be enrolled as a Medicare provider under the clinical psychologist designation and have a national provider identifier (NPI) number.
Q. Do I have to apply for the PQRI in order to participate in the 2009 program?
A. No, you can simply begin reporting on services provided on or after January 1, 2009.
Q. Do I have to start immediately in January?
A. No, but you should not take too long to decide. Because you must report on 80 percent of the applicable cases during the reporting period, failure to start early could prevent you from reaching this threshold and make you ineligible for the bonus payment.
Q. What good does it do to have only a few measures to report on?
A. So long as you report on at least one measure in 80 percent of the applicable cases you will be eligible for the 2.0 percent bonus.
Q. Where can I learn more about PQRI reporting?
A. The CMS Web site contains detailed specification worksheets for each measure. Worksheets for the measures with numbers listed above can be found at www.cms.hhs.gov/pqri under the heading Measures/Codes in the file labeled PQRI Quality Measure Specifications. The worksheet for the elder maltreatment screen and follow-up measure is still being finalized and will be posted on the website no later than December 31, 2008.
Q. What if I have further questions after reviewing the material posted online?
A. The best place to start is with your local Medicare contractor. Questions can also be directed to government relations staff for the APA Practice Organization by calling 202-336-5889 or sending an email to pracgov@apa.org.
PQRI_FAQ.pdf
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