Transcript of PQRS Video

Narrator: Diane Pedulla, JD
Length: 9:20

Intro, Title Slide 1

My name is Diane Pedulla and I’m the Director of Regulatory Affairs, Government Relations office, Practice Directorate of the American Psychological Association. I’m here to talk to you today about the physician quality reporting system and what it means for psychologists who participate in Medicare.

Intro, Title Slide 2

The Physician Quality Reporting System is a bonus program. Its designed to reward eligible professionals, including psychologists, who provide services for Medicare beneficiaries, in return for their reporting on measures on outpatient services. Many of you may have heard of this system before, previously known as the Physician Quality Reporting Initiative, or PQRI. For the current year, 2011, the system will pay a 1% bonus for all the Medicare charges you submit, not only for the ones which you will be reporting for.

Physician Quality Reporting System

We want to bring to your attention, however, that the system will be changing in the coming years, and therefor it is even more important that psychologists become familiar now with how the quality reporting system operates. For example, in 2012, the bonus payment will be reduced to 0.5 percent. It will remain at that level through 2014. More importantly, in 2015, the program will change. It will go from being a voluntary bonus program to one that will impose penalties for the failure to successfully report on outpatient measures. The penalty for not participating will be 1.5 percent in 2015 and 2 percent in 2016. This means that your total Medicare payments will be reduced if you are not successfully participating in this system by 2015. The advantage to psychologists for participating in the system in 2011 is that they will be eligible to earn a 1 percent bonus on their total Medicare charges.

Program Basics, Slide 1

It is actually very easy to begin participating in the quality reporting system. You must first be a Medicare provide with a national provider identification number. You would report individual measures using the CMS 1500 form that you use to submit Medicare claims. CMS is exploring the use of electronic health records for quality reporting, but at this time, most psychologists would report individual measures using the 1500 claims form.

Program Basics, Slide 2

For 2011, you are required to report on at least 50 percent of your applicable cases. You are encouraged to report on an least 3 measures; however, if there are not 3 measures that would be available to you, you may successfully report on as  little as 1 measure. You will also have the option of reporting on the entire calendar year, or only on the final 6 month period from July to December. As stated before, the bonus payments that you will receive will be based on your total Medicare charges, not just the services on which you will be reporting.

What is a measure?

What exactly is a measure? A measure consists of 2 components. The denominator describes the eligible cases, in other words, the patient population from which you may be reporting on. The numerator describes the action that is required. It’s important to understand here that at this time in the program, you are not being judged on your performance. Instead, CMS is looking for data to determine what type of action is being taken when services are provided. We’ll explain this a bit more when we show you the examples of a current measure.

Measure #107: Major Depressive Disorder (MDD): Suicide Risk Assessment

Measure number 107. Major depressive disorder, suicide risk assessment is one of 10 measures currently being used by psychologists. It is designed to determine how many patients - 18 years or older- who have been diagnosed with major depressive disorder have had a suicide risk assessment.

Example: Measure 107, Slide 1

To walk you through this example, the denominator in this case consists of patients 18 years of age or older who have a new or reoccurring episode of major depressive disorder. This is indicated by the ICD-9 code that reflects the major depressive disorder. When reporting on the measure, you are also required to indicate the CPT code for the service that is being provided. So for example, if you are performing the assessment during a psychiatric diagnostic interview then your claim form will reflect a 90801 CPT code. If the assessment is being done during a 45 minute outpatient psychotherapy session the CPT code used would be 90806.

Example: Measure 107, Slide 2

For purposes of the measure, the numerator reflects whether or not the suicide risk assessment actually took place. You would indicate if it was done using one particular number assigned on the worksheet for the measure. You would also have the option of indicating if it was not done because the patient was not eligible. A third option is that you can indicate that the suicide risk assessment was not done, with no reason being specified. Again, the current system is looking for providers to report data- it is not assessing performance.

2011 Reporting System Measures

As I said, there are 10 measures that are available to psychologists for 2011. There are 3 on Major Depressive Disorder: numbers 9, 106 and 107. There is also a body mass index, number 128. There is the opportunity to report documentation and verification of current medications in the medical record, number 130. There is a pain assessment measure, which is used prior to the initiation of treatment, number 131. There is a screening for clinical depression, number 134.

2011 Reporting System Measures, Slide 2

Measure number 173 involves unhealthy alcohol use. There is an elder maltreatment screen and follow up plan measure, number 181, which may be of particular interest to psychologists who are treating patients in nursing facilities.


For more information on this particular measure, read the article in the November 2010 edition of PracticeUpdate.

2011 Reporting System Measures, Slide 2 (again)

Finally, there is a new measure on preventive care and screening for tobacco use, measure number 226. This replaces two previous tobacco use measures.

Key Reporting Resources

For psychologists who have not yet begun to participate in the reporting program, there is a wealth of information available online. The Centers for Medicare and Medicaid services have made numerous documents available which will help you understand how the reporting system works, what you need to do to get started, and how to select from the individual measures and properly report on the measures when using the individual claim form. Simply follow the links on your screen to access the documents posted on the CMS website.

Thank You/Credits Slide

Psychologists who have any questions about the system may contact the Government Relations department at 202-336-5889.