A clinical registry is an organized system that collects data (reported by patients and providers) which are then used to better understand patients' health care history and experiences, as well as the quality of care they are being provided. With the increasing usage of electronic health records (EHR) and other novel approaches to collecting clinical information (e.g. patient portal), registries have emerged as a valuable method of using the latest information technology to capture data that will aid psychiatrists in making decisions about the most optimal patient care. Such registries are already being successfully used within other medical specialties and medical associations, including the American Academy of Neurology, American College of Cardiology, American Society of Clinical Oncology and many others.
APA developed this registry to help decrease routine administrative reporting burdens by consolidating and simplifying the production and submission process for the various regulatory and administrative demands faced by psychiatrists. This includes generating patient and progress reports, which help busy psychiatrists track patients' outcomes and provide clinical decision-support tools to inform evidence-based care.
APA is committed to helping psychiatrists meet new Medicare quality reporting requirements and maintain professional recertification—all in a way that avoids significant administrative burdens. Specifically, this registry helps members avoid payment penalties associated with failure to meet quality reporting requirements set by the Centers for Medicare & Medicaid Services (CMS) and by the Merit-Based Incentive Payment System. These payment penalties will increase progressively each year from 2019 to 2022 from 4% to 9%. The registry gives psychiatrists an easy and effective way to transmit quality reporting data to CMS and help them avoid these penalties.
The registry also gives psychiatrists a simple method of submitting Performance-in-Practice data and obtaining ABPN Maintenance of Certification (MOC) Part IV credit. Maintenance of Certification is critical to maintaining board certification and hospital credentialing. The registry's software generates automated reports and transmits them electronically to easily fulfill MOC Part IV.
Pertinent data will be extracted automatically from the EHR and registry portals and transmitted on a scheduled basis directly to PsychPRO's clinical data repository. Participating psychiatrists can access the data in the form of calculated quality measures that will help them examine their own patient population and benchmark practice performance to uncover potential areas for quality improvement. Importantly, a psychiatrist can also access real-time patient reported data for engagement and use during the clinical visit. Quality measure results can be compared to higher levels of aggregated data to answer questions, such as: "How are my patients with Major Depressive Disorder doing compared to patients with depression in the city, region, state, or nationally?"
Yes, the registry is currently in full operation.
We are onboarding participants and connecting with EHRs with the aim of meeting CMS quality reporting requirements under the MIPS program for the 2017 reporting year. PsychPRO contains 25 MIPS measures to choose from, as well as, feedback mechanisms for you to understand and improve on your quality measures including a detailed dashboard that allows for drill down to the patient-level for a view into the clinical care processes that can be modified or implemented for improvement.
We have also deployed our clinician and patient portals for collecting patient-reported outcome data (PROMS), which are powerful because they use validated questionnaires to turn a symptom into a numerical score for defining good outcomes. By making PROMs an integral part of clinical care, providers can use them to improve patient care.
If you do not have an EHR, the clinician and patient portals also allow for manual data entry to meet MIPS reporting requirements.
As we continue to build, we are interested in hearing from you in order to understand how best to provide a tool that will meet all of your quality and measurement-based care needs.
All practices will be encouraged to implement the patient portal for full registry participation and to take advantage of the information provided with patient reported measures in the delivery of high quality care. For practices with geriatric or SMI populations, the registry is being developed with consideration of the difficulties that are faced by these patients in accessing and using a patient portal. Features will include: (i) registry options for prescribing measures to proxies or care-givers; (ii) an audible function for measure items to be read aloud to patients; (iii) increased font size automatically presented in the portal for anyone over the age of 65; and (iv) physician prescribing of measures to be completed at the practice just prior to the patient appointment, which means measures do not have to be accessed via an email link.
Participants have access to their own performance metrics on a quality dashboard which features drill-down capability to view the data that comprise each quality measure. Participants will be able to drill-down to the patient-level to understand whether the documented patient care met the reporting standard. In addition, the registry participants can use the registry to compare their performance to similar practices at the regional and national level. It is also possible to make comparisons over time within a physician's own practice to help track and assess the impacts of practice quality improvement initiatives.
Participants not only have access to their performance metrics, by using the patient portal component of the registry they will also have access to patient reported outcome data in real-time so they may use this valuable information to engage patients and help in the planning and follow-up of their patients' care.
If a clinician wishes to submit reports that meet all the performance categories of CMS' Merit-based Incentive Program (MIPS), then a certified electronic health record technology (CEHRT) is required—particularly to meet the requirements for the Advancing Care Information (ACI) category. However even without a certified EHR, participants can still submit reports that meet the other MIPS categories by joining the registry. Even if a clinician does not meet the ACI performance category, participating in the registry can still help avert a potential financial penalty (it may just lower their total composite score, which may make it harder to achieve a financial bonus).
For example, in the 2017 reporting period (a transitional year), participants without an EHR will still be able to avert a penalty by implementing PsychPRO's electronic patient and clinician portals. The registry's electronic portals are used for collecting patient reported outcome measures and other medical and clinical data to be used in patient engagement and care. These data can be used by the registry to calculate, report and attest to CMS in the other performance categories including quality and improvement activities (IA).
Yes, APA has received CMS certification as a Quality Clinical Data Registry for the 2017 reporting period to present.
PsychPRO currently has more than 30 Merit-based Incentive Payment System (MIPS) quality measures implemented for use by participants:
|QPP||47||Advance Care Plan|
|QPP||128||Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan|
|QPP||130||Documentation of Current Medications in the Medical Record|
|QPP||134||Preventive Care and Screening: Screening for Depression and Follow-Up Plan|
|QPP||154||Falls: Risk Assessment|
|QPP||155||Falls: Plan of Care|
|QPP||181||Elder Maltreatment Screen and Follow-Up Plan|
|QPP||182||Functional Outcome Assessment|
|QPP||226||Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention|
|QPP||238||Use of High-Risk Medications in the Elderly|
|QPP||282||Dementia: Functional Status Assessment|
|QPP||286||Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia|
|QPP||288||Dementia: Education and Support of Caregivers for Patients with Dementia|
|QPP||370||Depression Remission at Twelve Months|
|QPP||374||Closing the Referral Loop: Receipt of Specialist Report|
|QPP||383||Adherence to Antipsychotic Medications For Individuals with Schizophrenia|
|QPP||391||Follow-Up After Hospitalization for Mental Illness (FUH)|
|QPP||402||Tobacco Use and Help with Quitting Among Adolescents|
|QPP||414||Evaluation or Interview for Risk of Opioid Misuse|
|QPP||431||Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling|
|NonQPP||APAMBC 1||Measurement-Based Care: Initial standardized assessment for all patients seen for mental health and/or substance use care
New: Measurement-Based Care: Standardized assessment for all individuals seen for mental health and/or substance use care.
|NonQPP||APAMBC 2||Measurement-Based Care: Monitoring of symptoms, functioning, and recovery for all patients seen for mental health and/or substance use care
New: Measurement-Based Care: Monitoring of symptoms, functioning, and recovery for all individuals seen for mental health and/or substance use care.
|NonQPP||APAMBC 3_2||Measurement-Based Care: Treatment or care plan adjustment for all patients seen for mental health and/or substance use care.
New:3b. Measurement-Based Care: Care plan adjustment for all individuals seen for mental health and/or substance use care.
|eCQM||CMS128v8||Anti-depressant Medication Management|
|eCQM||CMS136v9||Follow-Up Care for Children Prescribed ADHD Medication (ADD)|
|eCQM||CMS137v8||Initiation and Engagement of Alcohol and Other Drug Dependence Treatment|
|eCQM||CMS149v8||Dementia: Cognitive Assessment|
|eCQM||CMS155v8||Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents|
|eCQM||CMS161v8||Adult Major Depressive Disorder (MDD): Suicide Risk Assessment|
|eCQM||CMS177v8||Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment|
Security and Privacy
Practices that join PsychPRO enter into an agreement with APA, which includes a HIPAA-compliant Business Associate Agreement. Protected Health Information and identifiable provider information will be captured and stored by the registry in accordance with federal and state laws and regulations.
The registry will not publish any identifiable provider or practice data without permission. The registry will not have direct access to a patient's Protected Health Information (PHI) but rather to a limited set of de-identified data that correspond to the actual PHI. Only the provider's home institution or practice will have access to the PHI data, which they can use for their own needs and for quality reporting to CMS. To ensure confidentiality of patient information, data in the registry will be stored separately, in compliance with federal and state laws.
No one will have access to your data without your written permission. The process includes each provider signing a Data Release Consent Form allowing the registry to submit their data on their behalf. PsychPRO Registry collects, stores and reports data on a psychiatrist's behalf, taking every measure possible to safeguard it. APA's technology partner, FIGmd, is compliant with all local and federal regulations governing these areas, including HIPAA provisions and the recently updated provisions as part of the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health Act.
Based on the limited data set in the registry, APA will be able to publish benchmarks that can be used to assess psychiatrists' outcomes, practice patterns and utilization of new technology to look at overall trends in outcomes for the patient population. Mental health registry data will also allow APA to better focus its educational programming and service offerings for members.
Cost and Requirements of Participation
Individual Practitioners and Small Practices (less than 10 participating clinicians)
- $1,500 first year EHR integration fee
- $350 annual fee
- $250 per clinician annual MIPS reporting fee (if applicable)
- APA Member benefit - APA Members receive a waiver of the annual fee and waiver of first-year EHR integration fee if they use a Registry Ready Certified EHR, plus a reduced fee of $150 per clinician for MIPS reporting
Mid-Sized Practices (11-100 participating clinicians)
- $2,500 first year EHR integration fee
- $1,000 annual fee
- $150 per clinician annual MIPS reporting fee (if applicable)
Large Practices and Hospital Systems (101+ participating clinicians)
- $5,000 first year EHR integration fee
- $3,500 annual fee
- $150 per clinician annual MIPS reporting fee (if applicable)
PsychPRO will be easy to use, timely and responsive to the needs of the profession. It is designed to require minimal input and data entry from your staff. Using an EHR, you or a staff person can expect to spend an average of 1 hour per week for about 3 weeks to assist in the installation. Following installation, there is at a minimum, at least one hour required per year with FIGmd to review the quality dashboard prior to data being submitted to CMS for MIPS reporting. If you wish however, more time with the quality dashboard to review your performance scores will help with ongoing quality improvement.
To initiate participation in the registry, the psychiatrist or designated person at the site will need to sign two agreements with APA: (a) Participation Agreement and (b) Business Associate and Data Use Agreement that do the following:
- Permits APA to download the software to establish a VPN connection;
- Represents that patients have given appropriate permissions for their data to be used for quality reporting purposes and research using de-identified data;
- Addresses data safety, privacy, security, and insurance issues to protect all parties;
- Identifies appropriate uses of the data; and
- Generally, outlines the parties' expectations and obligations
The IRB approval that APA will obtain will be extended to participating psychiatrists. If a psychiatrist is covered by another IRB, APA will assist to obtain that IRB's approval.
Yes, members may terminate or begin their participation in the registry at any time. Timing of beginning of participation is governed by the numbers of people interested at any given time.
To ensure the PsychPRO Registry infrastructure is properly developed with features and functionalities that meet the needs of psychiatrists, the registry is currently only open to psychiatrists practicing in the U.S. and its territories. In the future, APA will examine the possibility of expanding the PsychPRO Registry to include international participants.
It is not required that all physicians within a practice participate in the registry. However, participation by all physicians in a practice is strongly encouraged to generate data that most accurately reflects practice performance.
Individual institutions will eventually be able to access their own data via secure dashboards for their own internal benchmarking. APA will apply to the APA Institutional Review Board for approval to make de-identified data available for future research purposes. In addition, informed consent will be obtained from psychiatrists and patients to potentially be re-contacted if they are eligible for specific studies. APA will establish an oversight group to set PsychPRO research and publication policies and procedures.