2011 brings changes to Physician Quality Reporting Initiative

PQRI changes make qualifying for bonus payments easier

by Government Relations Staff

November 18, 2010 — With the final rule for the 2011 Medicare fee schedule now posted on the website of the Federal Register, some noticeable changes have been made to the Physician Quality Reporting Initiative (PQRI).

Currently a voluntary program, the PQRI provides financial incentive for health care professionals, including psychologists, who participate in Medicare to report data on specific quality measures to the Centers for Medicare and Medicaid Services (CMS).  The final rule will be published in the Federal Register on November 29 but is currently available online at the Office of the Federal Register.

In 2010, providers who report on 80 percent of applicable cases for a given measure are eligible for a bonus payment equal to 2 percent of their total allowed Medicare charges for the reporting period. For 2011, CMS has reduced the reporting requirement for individual measures from 80 percent to 50 percent of applicable cases.

The bonus payment percentages have been reduced along with the reporting requirement. In 2011, the bonus payment will be 1 percent, and in 2012 through 2014, it will be 0.5 percent. The PQRI is expected to become mandatory in 2015, with penalties for failure to report.

Previously mandating a one year reporting period, CMS will now allow for a six-month reporting period for claims-based reporting as well. Psychologists can choose to report on services from January to December, or only on those furnished from July to December.

In order to participate, psychologists must have a national provider identifier (NPI) number and as of January 1, 2011, will need to be enrolled in the Medicare PECOS system. There is no application process, and providers can begin reporting on applicable cases at any time.

Elder maltreatment screen and follow-up plan

As of 2010, psychologists have ten measures available for reporting. These measures were designed to identify problems psychologists commonly observe when providing services such as psychotherapy. 

One measure available in 2010, Preventive Care and Screening: Inquiry Regarding Tobacco Use, will be replaced in 2011 by a new measure entitled Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention.

Measure 181, the elder maltreatment screen and follow-up plan, is an important opportunity for psychologists to provide feedback on older patients. The measure should be reported for each initial patient evaluation during the reporting period for patients aged 65 years and older.

The components that should be addressed in the screen for elder maltreatment are: 

  1. physical abuse

  2. emotional or psychological abuse 

  3. neglect 

  4. sexual abuse

  5. abandonment 

  6. financial or material exploitation 

  7. self-neglect 

  8. unwanted control

“This measure helps psychologists understand all the risks older adults face — it gives them an opportunity to intervene in a way they might not have otherwise thought of,” said Merla Arnold, PhD, RN, a licensed psychologist and registered nurse in Long Island, NY who specializes in the treatment and needs of older adults.

Dr. Arnold was part of the Phase II development process for the measure, and was elected Chair of the Psychology Expert Work Group that collaborated on the creation process. “We looked at defining and identifying key elements that should be considered when doing initial treatment/assessment plans for elder abuse and neglect,” said Dr. Arnold. “We redefined the scope and broadened the measure to the elder maltreatment screen and follow up plan.”

The measure does not prescribe specific assessment tools; psychologists reporting on the measure can do so by documenting narrative notes, a formal screen and/or assessment, treatment plan tools, or forms or referral requests for further evaluation. The measure is not intended to reflect quality of care, but rather to document that necessary care is being provided.

As of 2005, APA research indicated that 1 to 2 million Americans over the age of 65 were subject to abuse or neglect, often at the hands of those entrusted with their care.

Psychologists who see these adults on a routine or weekly basis have the opportunity to look for changes that could suggest a problem, and to intervene, according to Dr. Arnold. The measure is intended to be both corrective and preventive.

Older adults subjected to abuse, neglect or maltreatment often experience a high degree of shame. “This measure becomes an avenue to begin discussion,” said Dr. Arnold. “If you ask the question, there will be findings that will be important to follow up on because of how serious a problem” elder abuse, neglect and maltreatment is.

If measures are not reported on at a significant rate, they could potentially be eliminated in later fee schedule revisions. “This measure is intended to get psychologists to automatically consider older adults’ risk for abuse neglect or maltreatment,” said Dr. Arnold, “Then they can work with the older adult and link to other resources within the community to ensure the health and wellbeing of their patients.”

For more information about PQRI reporting, visit the CMS website or contact your local Medicare Administrative Contractor.