‘Use Or Lose’ Bonuses Ready To Go

By Paula Hartman-Stein, Ph.D.
March 1, 2008



Most psychologists, like other taxpayers, can expect economic incentive rebates when they file with the IRS this year, but only the most dilligent psychologists will receive special bonus payments next year. If this list of conditions does describe many of your therapy preferences, then you might be interested to know of the approach taken by Volunteers in Psychotherapy (VIP), a nonprofit organization developed by psychologists and nonprofit experts in Hartford, Conn., in 1999.

By performing, reporting and documenting at least three performance measures 80 percent of the time for specific clinical services in 2008, psychologists will be eligible for an extra 1.5 percent of total Medicare allowable billing under the Physicians Quality Reporting Initiative (PQRI).

According to Joe Casciani, Ph.D., president of Psychologists in Long Term Care, “It is very important that psychology actively participates in PQRI. There is a fair amount of paperwork and learning of procedures for a relatively small financial reward, but it appears that these quality measures will only increase in subsequent years for all professions.”

When beginning the PQRI process, psychologists must choose three of six available measures that include verification of current medications, pain assessment, patient co-development of the plan of care, screening for cognitive impairment, screening for clinical depression or using a completely electronic health record.

Debra Long, project manager of Quality Insights of Pennsylvania, the consulting firm that worked on developing the measures, said that the National Quality Forum gave a time-limited endorsement to the Centers for Medicare and Medicaid (CMS) of the 2008 measures because of inadequate testing in earlier development.

She encouraged psychologists to voluntarily participate in PQRI or risk losing the measures in subsequent years. “Although rewards are small now, it is better to get on board early so when measures and the program become more rigorous clinicians will understand the basic principles.”

James Georgoulakis, Ph.D., the APA representative to the Relative Update Committee of the American Medical Association, said hospitals must participate in PQRI by April 2008 or the government will reduce their payments by 2 percent a year until they meet the quality guidelines. The government will also publish a list of hospitals that do not meet quality standards.

Don Wilson, M.D., medical director for Quality Insights, said the project is now in its second phase because of a clear need for more specific measures addressing psychologists, physical therapists, occupational therapists, clinical social workers and chiropractors.

He encouraged all health disciplines to review and submit feedback on the proposed 2009 measures during the 30-day public comment period that began Feb. 8 and concludes March 10. According to Wilson, after the public comments are compiled Quality Insights of Pennsylvania will work with experts in their respective fields to revise the measures and pilot testing of the measures will begin.

The mental health measures include:

•Physical Health Status Screen
•Treatment plan of care for the person with cognitive impairment
•Complicated Grief Assessment in a co-existing disorder
•Initial Assessment for Post-traumatic Stress Disorder in a co-existing disorder
•Assessment for Obsessive Compulsive Disorder in a co-existing disorder
•Assessment of Suicide Risk in a co-existing disorder

“The true quality agenda,” Long said, “does not stop with either side of the political aisle. The performance measures are here to stay and will only grow for the benefit of the people we serve.”

Psychologists in Long Term Care has recently offered an educational conference call for its members regarding how to report and document the 2008 measures. The National Alliance of Professional Psychology Providers (NAPPP) is also planning a conference call for its members and APA has programming scheduled at its convention in August.

For more information on the measures available in 2008, go to the CMS website, www.cms.hhs.gov/PQRI/downloads/2008PQRIMeasuresSpecifications123107.pdf (PDF)

The drafted 2009 measures are posted at www.usqualitymeasures.org for online feedback submission.

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Paula Hartman-Stein, Ph.D., is chair for the first Psychology and Social Work Expert Work Group, Quality Measures project. She can be reached through her website, www.centerforhealthyaging.com

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