Update on the Medicare Physician Quality Reporting Initiative (PQRI)
CMS has recently released information concerning participation in the voluntary Physician Quality Reporting Initiative (PQRI) for 2009. While the first reporting period for 2009 began on January 1, physicians who did not begin reporting individual quality measures at that time can participate in a second reporting period that begins July 1, 2009 and ends December 31, 2009. However, participation in the second period is limited to the reporting of measure groups (described below) or reporting individual measures through a recognized registry (see CMS website for further details on registry reporting). Participating physicians who meet reporting targets are eligible for bonus payments equal to 2% of their total allowed charges for the reporting period—either the full calendar year or the last six months of 2009.
The number of reportable measures for 2009 totals 175 including 22 that are combined in seven measure groups for specific patient conditions—diabetes, chronic kidney disease, preventive care, coronary bypass surgery, rheumatoid arthritis, perioperative care, and back pain. Measures outside these groups may be reported on Medicare claims using specially designated codes. Measure groups may be reported directly on Medicare claims or through a recognized clinical registry (a list of qualified registries is posted on the CMS website), which will forward the data to CMS.
Measures of special interest to psychiatrists:
Depression – Major Depressive Disorder
#09. Antidepressant medication during acute phase for patients with major depressive disorder
#106. Diagnostic evaluation
#107. Suicide risk assessment
Online at:
http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/participation-tools-individual.shtml
Further details on measure specification and reporting instructions are on the CMS website at: http://www.cms.hhs.gov/pqri/01_overview.asp.
In general, to qualify for bonus payments for the entire 2009 calendar year, reporting physicians must report at least 3 applicable measures in at least 80% of the encounters in which the measure is reportable (if less than 3 measures are applicable, participants report only applicable measures). Physicians may also qualify for bonuses by reporting at least one or more measure groups if the groups are reported for at least a specified number of consecutive patients for whom the groups are applicable. (See CMS website for requirements related to reporting measure groups.)
CMS has also acknowledged a number of reporting problems and errors related both to physician submissions and claims processing procedures. For physicians reporting measures on claims, it is important to include the physician’s NPI number on the same line with the code for the measure being reported. In addition, physicians should take care to ensure that only measures for patients who meet the specifications of the measure (i.e., gender, age, diagnosis or procedure) are reported.
Additional information and assistance is also available at the AMA website, which has a number of tools related to PQRI participation: http://www.ama-assn.org/ama/no-index/physician-resources/17432.shtml.
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