Physician Quality Reporting System: Questions and answers for psychologists

by Government Relations Staff

What Is the Physician Quality Reporting System?

Formerly known as the Physician Quality Reporting Initiative (PQRI), the Physician Quality Reporting System 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). In 2015, the reporting program will shift from voluntary program to a mandatory one in which penalties will be assessed for failure to participate.

Is this a pay-for-performance program?

No. Pay for performance involves realigning incentives in the delivery of health care services to reward quality improvement. The Physician Quality Reporting System will allow health care professionals to earn bonus payments through 2014 just for reporting on the program's measures, regardless of the treatment outcomes.

The program has "physician" in the title, so how can psychologists participate?

Under the terms of the legislation that created the reporting program, a number of different health care professionals, including psychologists, are eligible for the Physician Quality Reporting System.

What do I stand to gain from participating?

Health care professionals who successfully report on 50 percent of the applicable cases for any given measure will be eligible for a bonus payment equal to one percent of their total allowed Medicare charges for the 2011 reporting period. That's one percent extra for all of the claims Medicare pays you for, not just the ones you report on. For 2012 – 2014, the bonus payment will be 0.5 percent. You will also receive confidential feedback reports from CMS.

So I will receive an extra one percent whenever I'm paid for a Medicare claim?

It doesn't happen that fast. All claims have to be filed before CMS calculates the bonus payments. The deadline for submitting prior year claims two months from the end of the calendar year, so bonus payments are issued in the middle of the next year.

How much work will it take to report the measures?

Reporting for the Physician Quality Reporting System is not intended 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 website under the category of Educational Resources. Information is also available from your local Medicare carrier.

Do the measures reflect the services I provide to Medicare beneficiaries?

During the initial reporting period that started on July 1, 2007, psychologists had limited opportunity to participate in the former PQRI program, 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. For 2012, psychologists have ten measures available for reporting in PQRS:

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)
Preventive care and screening: Body mass index screening and follow-up (#128)
Documentation and verification of current medications in the medical record (#130)
Pain assessment prior to initiation of patient therapy and follow-up (#131)
Screening for clinical depression and follow-up plan (#134)
Preventive care and screening: Unhealthy alcohol use—screening (#173)
Elder maltreatment screen and follow-up plan (new measure effective in 2009)
Preventive care and screening: Tobacco use assessment and tobacco cessation intervention (#226)

In addition, a new measures group for dementia has been created that can only be reported through a registry (PDF, 44KB) due to the way in which the measures must be analyzed.

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?

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.

What requirements do I have to meet to participate?

You must be enrolled as a Medicare provider under the clinical psychologist designation and have a national provider identifier (NPI) number. As of January 1, 2011, you must also be enrolled in the Medicare PECOS system.

Do I have to apply for the PQRS in order to participate in PQRS?

No, you can simply begin reporting on services provided on or after January 1 of the current year.

Do I have to start immediately in January of each year?

No, but you should not take too long to decide. Because you must report on 50 percent of the applicable cases during the 12-month reporting period, failure to start early could prevent you from reaching this threshold and make you ineligible for the bonus payment. CMS has eliminated the 6-month reporting period for individual measures reported through claims or a registry. For 2012, individual claims should be submitted for a 12-month reporting period.

What good does it do to have only a few measures to report on?

CMS suggests you report on at least three measures, but as long as you report on at least one measure in 50 percent of the applicable cases you will be eligible for the bonus payment.

Where can I learn more about PQRS reporting?

The CMS website contains detailed specification worksheets for each measure. Worksheets for the measures with numbers listed above can be found on the CMS website under the link for Measures/Codes. The 2011 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures (PDF, 2.64 MB) is also available on the CMS website, and the 2012 manual will be posted when it becomes available.

What if I have further questions after reviewing the material posted online?

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 phone at (202) 336-5889 or by email.

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