National Council Reviews Behavioral Health’s Role in Medicare Quality Initiatives
Medicare is well on its way to fully incorporating mental health and addiction treatment in its quality initiatives – and behavioral health providers should prepare now for this seismic shift in payment and accountability. That’s the core message of a new National Council report, “A Place at the Table: Behavioral Health and CMS’ Physician Quality Reporting System.”
The Centers for Medicare and Medicaid Services (CMS) has been taking leadership to transform itself from a passive payer of services into an active purchaser of higher quality, affordable care. CMS now has 26 separate quality initiatives in various stages of implementation, tracking 1,152 measures. One of these initiatives is the Physician Quality Reporting System (PQRS), a pay-for-reporting program that uses a combination of incentive payments and downward payment adjustments to promote reporting of quality information by eligible professionals.
The PQRS offers the potential for broad measurement of key behavioral health indicators such as depression screening, unhealthy alcohol use screening, and tobacco use screening. CMS has begun to use these quality indicators in screening mothers for postpartum and maternal depression, querying people with asthma about tobacco exposure, looking for depression in dementia and Parkinson’s patients, appraising for suicide risk in people with major depression, and more. CMS has even begun to work to ensure that care is meeting certain standards, measuring use of the Personal Health Questionnaire-9 (PHQ-9) for adult consumers and tracking care coordination for consumers with depression and other comorbid conditions.
The new National Council report shares information on how mental health and addiction treatment providers can engage in the PQRS. The report:
- Describes the CMS Quality Strategy – the framework CMS is using to address quality;
- Provides an overview of the Physician Quality Reporting System; and
- Suggests strategies for behavioral health providers to participate in the PQRS and leverage the benefits of participation.
Among the strategies the report recommends are: identifying staff members who are eligible professionals; selecting measures to report; developing an internal reporting system; crafting a standing plan for analyzing the data; and designing and implementing rapid cycle improvements.