Overview
The Physician Quality Reporting System (PQRS), a CMS (Centers for Medicare and Medicaid Services) quality improvement program continuing in 2013 provides the opportunity for incentives for participation (incentive: up to 0.5% of total Medicare allowed charges) and a penalty beginning in 2015 based on 2013 reporting (penalty: up to 1.5% of total Medicare allowed charges). PQRS, first established in 2006, offers incentives to Medicare providers who report on quality performance measures and assesses penalties to those providers who fail to report. Participation in the program involves the reporting of designated administrative codes on billing claims. Physicians who successfully participate in this program in 2013 will be listed on the new public Physician Compare Website. Actual performance on the measures, versus successful reporting, is expected to be reported on the website this year (2013). Detailed specifications for this program are on the CMS PQRS Page.
The PQRS program continues in 2013 with 259 measures for claims-based reporting. More information is available on the CMS website about other methods of reporting (registries, measures groups, group practice, and electronic health records) which may be an option in certain circumstances. Several measures are pertinent to psychiatrists, including five measures on depressive disorder, three measures on screening for unhealthy substance use, and one measure on medication reconciliation. In addition, a dementia measure set is available for use as a group, meaning if used, all nine measures within the set must be reported. Physicians who report on at least 3 measures applicable to their practice between January 1 and December 31, 2013 will receive a bonus of up to 0.5% of their total Medicare allowed charges for that period. If less than 3 measures apply to the eligible psychiatrist, 1-2 measures must be reported in at least 50% of encounters where a measure applies. The incentive is awarded for reporting on applicable measures, however, measures with a 0% performance rate will not be counted. Starting in 2015, there will be a 1.5% payment adjustment (financial penalty) for physicians who do not participate; the tracking for those who receive the 2015 penalty begins this year (2013). For 2015 only, the payment adjustment can be avoided by reporting one PQRS measure for at least one applicable patient using the claims, registry, or EHR reporting. Reporting requirements to avoid the penalty are expected to increase in future years. Preregistration is not a requirement to participate in the 2013 PQRS: submission of quality data codes for the 2013 PQRS quality measures to CMS through claims, a qualified registry or electronic health record (EHR) will indicate intent to participate in the 2013 program. To align the PQRS with the Medicare EHR Incentive Program, all clinical quality measures available for reporting under the Medicare EHR Incentive Program are included in the 2013 PQRS. This allows physicians to report data on quality measures under the EHR-based reporting option.
PQRS 2013 Measures
The following measures may be most pertinent to psychiatry, but others in the complete list of PQRS measures and specifications for 2013 may apply to individual practices. Please note the various reporting mechanisms available for use.
Measure #9
Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD
Reporting Mechanisms: Claims, Registry, or Electronic Health Record
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 #46
Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility
Reporting Mechanisms: Claims, Registry, or CMS-Selected GPRO (web-based interface)
Description: Percentage of patients aged 65 years and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 60 days following discharge in the office by the physician providing on-going care who had a reconciliation of the discharge medications with the current medication list in the medical record documented
Measure #47
Advance Care Plan
Reporting Mechanisms: Claims, Registry, or Electronic Health Record
Description: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Measure #106
Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity
Reporting Mechanisms: Claims or Registry
Description: Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with evidence that they met the DSM-IV-TR criteria for MDD AND for whom there is an assessment of depression severity during the visit in which a new diagnosis or recurrent episode was identified
Measure #107
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
Reporting Mechanisms: Claims or Registry
Description: Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified
Measure #130
Documentation of Current Medications in the Medical Record
Reporting Mechanisms: Claims or Registry
Description: Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration
Measure #134
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Reporting Mechanisms: Claims, Registry, or CMS-Selected GPRO (web-based interface)
Description: Percentage of patients aged 12 years and older screened for clinical depression on the date of encounter using an age appropriate standardized depression screening tool AND, if positive, a follow-up plan is documented on the date of the positive screen
Measure #173
Preventive Care and Screening: Unhealthy Alcohol Use – Screening
Reporting Mechanisms: Claims, Registry, or Electronic Health Record
Description: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method within 24 months
Measure #226
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Reporting Mechanisms: Claims, Registry, Electronic Health Record, or CMS-Selected GPRO (web-based interface)
Description: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user
Measure #238
Drugs to be Avoided in the Elderly
Reporting Mechanisms: Electronic Health Record
Description: Percentage of patients ages 65 years and older who received at least one drug to be avoided in the elderly and/or two different drugs to be avoided in the elderly in the measurement period
Measure #247
Substance Use Disorders: Counseling Regarding Psychosocial and Pharmacologic Treatment Options for Alcohol Dependence
Reporting Mechanisms: Claims or Registry
Description: Percentage of patients aged 18 years and older with a diagnosis of current alcohol dependence who were counseled regarding psychosocial AND pharmacologic treatment options for alcohol dependence within the 12-month reporting period
Measure #248
Substance Use Disorders: Screening for Depression Among Patients with Substance Abuse or Dependence Reporting Mechanisms: Claims or Registry
Description: Percentage of patients aged 18 years and older with a diagnosis of current substance abuse or dependence who were screened for depression within the 12-month reporting period
Measure #325
Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions Reporting Mechanisms: Registry
Description: Percentage of medical records of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) and a diagnosed comorbid condition (diabetes, coronary artery disease, ischemic stroke, intracranial hemorrhage, chronic kidney disease [stages 4 or 5], ESRD or congestive heart failure) being treated by another clinician with communication to the other clinician treating the comorbid condition
Dementia Measures Group
The Dementia Measure Set will again be included in this year’s PQRS performance measures. Please note this measure group must be reported on as a whole. To report on this group, CMS’s requirements for “measures groups” reporting must be followed.
Measure #280
Dementia: Staging of Dementia
Description: Percentage of patients, regardless of age, with a diagnosis of dementia whose severity of dementia was classified as mild, moderate or severe at least once within a 12 month period
Measure #281
Dementia: Cognitive Assessment
Description: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period
Measure #282
Dementia: Functional Status Assessment
Description: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of patient’s functional status is performed and the results reviewed at least once within a 12 month period
Measure #283
Dementia: Neuropsychiatric Symptom Assessment
Description: Percentage of patients, regardless of age, with a diagnosis of dementia and for whom an assessment of patient’s neuropsychiatric symptoms is performed and results reviewed at least once in a 12 month period
Measure #284
Dementia: Management of Neuropsychiatric Symptoms
Description: Percentage of patients, regardless of age, with a diagnosis of dementia who have one or more neuropsychiatric symptoms who received or were recommended to receive an intervention for neuropsychiatric symptoms within a 12 month period
Measure #285
Dementia: Screening for Depressive Symptoms
Description: Percentage of patients, regardless of age, with a diagnosis of dementia who were screened for depressive symptoms within a 12 month period
Measure #286
Dementia: Counseling Regarding Safety Concerns
Description: Percentage of patients, regardless of age, with a diagnosis of dementia or their caregiver(s) who were counseled or referred for counseling regarding safety concerns within a 12 month period
Measure #287
Dementia: Counseling Regarding Risks of Driving
Description: Percentage of patients, regardless of age, with a diagnosis of dementia or their caregiver(s) who were counseled regarding the risks of driving and driving alternatives within a 12 month period
Measure #288
Dementia: Caregiver Education and Support
Description: Percentage of patients, regardless of age, with a diagnosis of dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND referred to additional sources for support within a 12 month period
Links pertaining to 2013 PQRS Program:
CMS PQRS Website
CMS PQRS Help Desk Contact Information
CMS PQRS 2013 Measure Specifications
CMS PQRS 2013 Implementation Guide
2013 PQRS Participation Tools (AMA)
PQRS Educational Video Presentation