Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program
Updated: 4/22/2010
Overview
Two CMS (Centers for Medicare and Medicaid Services) quality improvement programs continuing in 2010 provide the opportunity for incentives of up to 4% of total Medicare allowed charges for participation: the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (e-prescribing) Incentive Program. PQRI, first established in 2006, offers incentives to Medicare providers who report on quality performance measures. The e-prescribing program offers incentives to clinicians who use a qualified e-prescribing system. Participation in both programs involves the reporting of designated administrative codes on billing claims. More information is available on the CMS website about other methods of reporting (registries and measures groups) which may be an option in certain circumstances.
The PQRI program continues in 2010 with 175 measures, including 3 on major depressive disorder, and a new measure on screening for unhealthy alcohol use. Physicians who report on at least 3 measures applicable to their practice between January 1 and December 31, 2010, or between July 1 and December 31, 2010 will receive a bonus of up to 2% of their total Medicare allowed charges for that period. To be eligible for the bonus, measures must be reported in at least 80% of encounters where a measure applies. The incentive is awarded for reporting on applicable measures, regardless of whether or not the measure was met.
The Electronic Prescribing Incentive Program is continues in 2010. Clinicians who meet the requirements for being a successful e-prescriber will be eligible for an additional 2% bonus in 2010. Being a successful e-prescriber means reporting 25 instances of electronic prescribing using a qualified system during the course of the calendar year. APA members currently using an electronic prescribing system are encouraged to share their impressions with other members at http://www.psych.org/softwarereview.
Detailed specifications for these programs are on the CMS PQRI Page and the CMS E-Prescribing Incentive Page. CMS has posted PQRI Help Desk contact information here. Check this page (psych.org/pqri) periodically for updates and more information on these programs.
Electronic Prescribing Incentive Program
Adoption/Use of Medication Electronic Prescribing Measure
Description: Documents whether the provider has adopted a qualified e-prescribing system and the extent of use in the ambulatory setting. A qualified electronic prescribing system must be capable of:
- 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
- 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 (if available)
The Electronic Prescribing Incentive Program Measure now includes the psychiatric pharmacologic management procedure code 90862. A psychiatrist using a qualified electronic prescribing system is eligible for the full bonus (2% of all Medicare Part B charges) if s/he reports electronic prescriptions associated with at least 25 unique patient visits over the course of the year, and at least 10% of his/her total estimated Medicare Part B charges derive from procedure codes that are included in the measure (e.g. 90862, 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 99201, etc., see the measure specifications for the full list). An administrative code, G8553, is reported on the claim for an encounter where at least one prescription was generated and transmitted electronically.
PQRI 2010 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 for 2010 can be found here.
Measure #9
Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD
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
Major Depressive Disorder (MDD): Diagnostic Evaluation
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
Major Depressive Disorder (MDD): Suicide Risk Assessment
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
Health Information Technology (HIT) - Adoption/Use of Electronic Health Records (EHR)
Description: Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted and be using a certified/qualified EHR
Measure #173
Preventive Care and Screening: Unhealthy Alcohol Use – Screening
Description: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method within 24 months
Other Measures
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). Certain measures, such as Screening for Clinical Depression (#134), and Elder Maltreatment Screen and Follow-up Plan (#181), may be pertinent to mental health but are only for non-MD/DO professionals.
Links
Links pertaining to 2010 PQRI Program:
CMS PQRI Website
CMS PQRI 2010 Measure Specifications
CMS PQRI Tip Sheet: Satisfactorily Reporting 2010 PQRI Measures
CMS 2010 PQRI Fact Sheet: What's new for 2010
CMS PQRI 2010 Implementation Guide
2010 PQRI Data Collection Worksheets (AMA)
Implementation Advice for 2009 PQRI and E-Prescribing (CMS)
Links pertaining to Electronic Prescribing Incentive Program:
CMS Electronic Prescribing Incentive Program Website
CMS Electronic Prescribing Incentive Program Made Simple
CMS Electronic Prescribing Incentive Fact Sheet
A Clinician’s Guide to Electronic Prescribing (eHealth Initiative)
AMA Page on the Electronic Prescribing Incentive Program
Listing of electronic prescribing products (Surescripts)
Get Connected: information for physicians on Electronic Prescribing (Surescripts)
Additional Electronic Prescribing Resources