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 as part
of Medicare's pay-for-performance program (see Funding, Logistics Deter
Electronic-Record Adoption). 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 final rule
provides details on how the PQRI program will continue in 2008 with 119
measures, including three on major depressive disorder ("Antidepressant
Medication During Acute Phase for Patients With New Episode of Major
Depression," "Patients Who Have Major Depressive Disorder Who Meet
DSM-IV Criteria," and "Patients Who Have Major Depressive
Disorder Who Are Assessed for Suicide Risks").
As it currently stands, physicians who report on applicable measures in at
least 80 percent of their covered encounters between January 1 and December
31, 2008, will receive a bonus of up to 1.5 percent of their total
Medicare-allowed charges for that period. A physician is required to report on
at least three 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.
CMS has developed a tip sheet to assist clinicians participating in the
PQRI in reporting their data accurately. That information includes a reminder
that some reporting measures require more than one CPT-II or G-code,
and all codes must be included on the claim.
Modifications to this program are still possible before the scheduled
January 1, 2008, start date. Check the CMS PQRI Web site at<www.cms.hhs.gov/pqri>
and the APA Web site<www.psych.org/psych_pract/pqri.cfm?pf=y>
for updates, more detailed information, measure specifications, and additional
resources. The PQRI tip sheet is posted at<www.cms.hhs.gov/PQRI/Downloads/2007PQRITipSheet.pdf>.