Physician Quality Reporting Initiative (PQRI)
Overview
The Tax Relief and Healthcare Act of 2006 authorized the creation of the Physician Quality Reporting Initiative (PQRI) by the Centers for Medicare and Medicaid Services (CMS). PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. CMS issued a list of 74 physician quality measures earlier this year for reporting in 2007, including one on Major Depressive Disorder. The 2008 Medicare Physician Fee Schedule (MPFS) final rule provides details on how the PQRI program will continue in 2008 with 119 measures, including 3 on Major Depressive Disorder. As it currently stands, physicians who report on applicable measures in at least 80% of their covered encounters between January 1 and December 31, 2008 will receive a bonus of up to 1.5% of their total Medicare-allowed charges for that period. A physician is required to report on at least 3 of the 119 measures applicable to their practice to be eligible for the bonus. The incentive is awarded for reporting on applicable measures, regardless of whether or not the measure was met.
Program details were last modified December 31, 2007. Check the CMS page, this page, and the AMA page on PQRI for updates and more information on this program.
Measures
The following measures may be most pertinent to psychiatry, but others may apply to individual practices. The complete list of PQRI measures and specifications can be found here.
A physician is required to report on at least 3 of the 119 measures to be eligible for the full bonus. There are 3 measures specifically targeting Major Depressive Disorder (MDD):
Measure #9: Antidepressant Medication During Acute Phase for Patients with News Episode of Major Depression
Measure #106: Patients who have Major Depression who meet DSM-IV Criteria
Measure #107: Patients who have Major Depression who are Assessed for Suicide Risks
There are other measures that are pertinent to psychiatrists who are using Electronic Health Records or electronic prescribing:
Measure #124: HIT - Adoption/Use of Health Information Technology (Electronic Health Records)
Measure #125: HIT - Adoption/Use of e-Prescribing
General measures, such as Medication Reconciliation (#46), Advance Care Plan (#47), Inquiry Regarding Tobacco Use (#114), and Advising Smokers to Quit (#115) may also apply for psychiatrists who routinely use certain general medical CPT evaluation and management codes (e.g. 99201).
Measure #9
Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression
Description: Percentage of patients aged 18 years and older diagnosed with new episode of major depressive disorder (MDD) and documented as treated with antidepressant medication during the entire 84-day (12 week) acute treatment phase.
Measure #106
Patients who have Major Depressive Disorder who meet DSM-IV Criteria
Description: Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of major depressive disorder (MDD) who met the DSM-IV criteria during the visit in which the new diagnosis or recurrent episode was identified during the measurement period
Measure #107
Patients who have Major Depressive Disorder who are Assessed for Suicide Risks
Description: Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of major depressive disorder (MDD) who had a suicide risk assessment completed at each visit during the measurement period
Measure #124
HIT - Adoption/Use of Health Information Technology (Electronic Health Records)
Note: This measure applies only to physicians who have already adopted an Electronic Health Record.
Description: Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted a qualified electronic medical record (EMR). For the purpose of this measure, a qualified EMR can either be a Certification Commission for Healthcare Information Technology (CCHIT) certified EMR or, if not CCHIT certified, the system must be capable of all of the following:
- Generating a medication list
- Generating a problem list
- Entering laboratory tests as discrete searchable data elements
Measure #125
HIT - Adoption/Use of e-Prescribing
Note: This measure applies to physicians who have already adopted electronic prescribing.
Description: Documents whether provider has adopted a qualified e-Prescribing system and the extent of use in the ambulatory setting. To qualify this system must be capable of ALL of the following:
- Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
- Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (defined below)
- Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
- Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan
Links
CMS PQRI Website
CMS PQRI 2008 Measure Specifications
Coding for Quality - A Handbook for PQRI Participation
CMS PQRI Tip Sheet
2008 PQRI Data Collection Worksheets
CMS PQRI 2008 PowerPoint Presentations
December 19, 2007
Articles on PQRI
Psychiatric News - December 21, 2007