CMS Physician Quality Reporting Initiative: Changes for 2008

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 Original article: 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>.