PQRS measures for 2016

By Government Relations staff

There are 13 individual PQRS measures in 2016 that are most likely to be used by psychologists depending upon the population they treat, the services they provide and the way in which they report. The individual measures are:

• Body mass index (No. 128): Indicates the percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documents in the medical record and if the most recent BMI is outside parameters, a follow-up plan is documented. The measure may be reported when a BMI calculation has been performed in the office or facility or by another health care provider and is documented within the previous six months in outside medical records obtained by the provider.
  NQS Domain: Community/Population Health. This is a cross-cutting measure.
• Documentation and verification of current medications in the medical record (No. 130): Indicates the percentage of patients aged 18 years and older with a list of current medications with dosages (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) and verification with the patient or authorized representative is documented by the provider. This measure is to be reported at each visit occurring during the 12-month reporting period. There is no diagnosis associated with this measure.
  NQS Domain: Patient Safety. This is a cross-cutting measure.
• Pain assessment prior to initiation of patient treatment (No. 131): Indicates the percentage of patients aged 18 years and older with documentation of a pain assessment (if pain is present, including location, intensity and description) through discussion with the patient including the use of a standardized tool on each qualifying visit prior to initiation of therapy and documentation of a follow-up plan. This measure is to be reported for each qualifying visit occurring during the reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure.
  NQS Domain: Communication and Care Coordination. This is a cross-cutting measure
• Screening for clinical depression (No. 134): Indicates the percentage of patients aged 18 years and older screened for clinical depression using a standardized tool and follow-up plan documented. This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure.
  NQS Domain: Community/Population Health. This is a cross-cutting measure.
• Elder maltreatment screen and follow-up plan (No. 181): Indicates the percentage of patients aged 65 years and older with documentation of a screen for elder maltreatment and documented follow-up plan. This measure is to be reported once during the reporting period for patients seen during the reporting period. When reporting CPT codes 96116, 97803, and G0270 the measure is to be reported each time the code is submitted. The not eligible code can be used to report if it is not an initial evaluation with screening for elder maltreatment.
  NQS Domain: Patient Safety
• Preventive care and screening: tobacco use — screening and cessation intervention (No. 226): 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. This measure is to be reported once per reporting period.
  NQS Domain: Community/Population Health. This is a cross-cutting measure.

The following measures may only be reported through a registry.

• Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (No. 325): Indicates the Percentage of medical records of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) and a specific 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. This measure is to be reported a minimum of once per reporting period for patient with a diagnosis of MDD seen during the reporting period.
  NQS Domain: Communication and Care Coordination
• Depression Remission at Twelve Months (No. 370): The percentage of adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score>9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. This measure is to be reported once per reporting period.
  NQS domain: Effective Clinical Care
• Adherence to Antipsychotic Medications for Individuals with Schizophrenia (No. 383): The percentage of individuals 18 years of age or greater as of the beginning of the measurement period with schizophrenia or schizoaffective disorder who are prescribed an antipsychotic medication. This measure is also eligible for EHR reporting.
  NQS Domain: Patient Safety
• Follow-up After Hospitalization for Mental Illness (No. 391): The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. This measure is also eligible for EHR reporting.
  NQS Domain: Communication and Care Coordination
• Tobacco Use and Help with Quitting Among Adolescents (#402): The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for who tobacco use status was documented and received help with quitting if identified as a tobacco user. This measure is to be reported once per reporting period.
  NQS Domain: Community/Population Health
• Depression Remission at Six Months (No. 411): The percentage of adult patients 18 years and older with major depression or dysthymia and an initial PHQ-9 score>9 who demonstrate remission at six months defined as a PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
  NQS Domain: Communication and Care Coordination.
• Evaluation or Interview for Risk fo Opioid Misuse (No. 414): All patients age 18 and older prescribed opiates for longer than six weeks duration evaluated for risk of opioid misuse using a brief validated instrument or patient interview documented at least once during Opioid Therapy in the medical record.
  NQS Domain: Effective Clinical Care
• Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (No. 431): The percentage of patients aged 18 and older who were screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND who received brief counseling if identified as an unhealthy alcohol user.
  NQS Domain: Community/Population Health. This is a cross-cutting measure.

Measures groups are a subset of four or more PQRS measures that have a particular clinical condition or focus in common. All applicable measures within a group must be reported for each patient within the sample that meets the required criteria (such as age or gender). Eligible professionals can choose more than one reporting option (individual measures or measures groups), but can only earn a maximum of one incentive payment equal to 0.5 percent of their total estimated allowed Medicare charges.

In 2016 there is still one measures group on dementia that can be reported by psychologists. The Dementia Measures Group consists of nine measures: Preventive care and screening: Screening for clinical depression and follow-up plan (No. 134), Staging of dementia (No. 280), Cognitive assessment (No. 281), Functional status assessment (No. 282), Neuropsychological symptom assessment (No. 283), Management of neuropsychiatric symptoms (No. 284), Counseling regarding safety concerns (No. 286), Counseling regarding risks of driving (No. 287), and Caregiver education and support (No. 288). The Dementia Measures Group is reportable through registry reporting only. Measure No. 285, Screening for clinical depressive symptoms, which was available in 2015, was replaced by measure No. 134. 

Psychologists who do not find any measures in this entire list to be applicable to their services and/or patient population are advised to contact the CMS QualityNet Help Desk for assistance. The QualityNet Help Desk is available Monday through Friday, 7 a.m.-7 p.m. CT, by telephone at (866) 288-8912 (TTY (877) 715-6222). Inquiries may be sent by email.

December 2015