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Clinical Social Work Practice Update

2009 Medicare Bonus Incentive Program for Clinical Social Workers

Mirean Coleman, MSW, LICSW, CT
April 2009

NASW encourages clinical social workers who are Medicare providers to participate in the optional 2009 Medicare Bonus Incentive Program. Doing so not only increases practice revenue, but prepares clinical social workers to document performance measures prior to their permanent implementation within several years.

Background

The Physician Quality Reporting Initiative (PQRI) was established by the Tax Relief and Health Care Act of 2006 (TRHCA). It is a quality reporting system for Medicare providers and was first implemented during the period of July 1, 2007 through December 31, 2007. It was successfully implemented for the second time from January 1, 2008 through December 31, 2008.

Current Program

The final rule of the 2009 Medicare Physician Fee Schedule continues PQRI for 2009 and includes a two percent bonus incentive payment of the total allowed charges for Medicare covered services performed by each provider. Although participation in PQRI for 2009 is optional for clinical social workers and other Medicare providers, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made PQRI a permanent program and authorized bonus incentive payments through 2010 only. In the future, Medicare plans to convert to a value-based purchasing system, and may require clinical social workers and other providers to report performance measures in order to receive payment. Therefore, it is important for clinical social workers to participate in the optional bonus incentive program now to learn how to document measures.

Measures

PQRI identifies specific measures that may be used by clinical social workers to improve the quality of care provided to Medicare beneficiaries.  These measures are standards of care based on evidence-based practices.  For 2009, there are a total of 153 available performance measures. Clinical social workers have access to ten of the measures which are as follows:

Measure Number	Measure Title
9	Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD
106	Major Depressive Disorder (MDD): Diagnostic Evaluation
107	Major Depressive Disorder (MDD): Suicide Risk Assessment
115	Preventive Care and Screening: Advising Smokers to Quit
124	Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)
130	Documentation and Verification of Current Medications in the Medical Chart
131	Pain Assessment Prior to Initiation of Patient Therapy and Follow-Up
134	Screening for Clinical Depression and Follow-Up Plan
173	Preventive Care and Screening: Unhealthy Alcohol Use – Screening
181	Elder Maltreatment Screen and Follow-Up Plan

The following 2008 measures used by clinical social workers were retired as of January 1, 2009 and are not available for use as performance measures in the 2009 PQRI Program.

Measure Number	Measure Title
132	Patient Co-Development of Treatment Plan/Plan of Care
133	Screening for Cognitive Impairment

Instructions

Instructions and tools for using the 2009 measures are located online at www.cms.hhs.gov/pqri. Clinical social workers do not need to sign-up or pre-register to participate in PQRI. Participation in the 2009 PQRI is indicated by reporting quality data codes on the CMS-1500 Form during the 2009 reporting period. The deadline for filing claims to receive the 2009 bonus incentive payment is February 28, 2010.

The Physician Consortium for Performance Improvement (PCPI) has been selected by the Centers for Medicare and Medicaid Services (CMS) to enhance the quality and value of patient care by developing evidence-based performance measures for health care providers. Information about PCPI is available online at www.physicianconsortium.org. Through PCPI, NASW is advocating for additional performance measures for clinical social workers to use when participating in PQRI.

Additional information on PQRI is available online at the following CMS Web page:  www.cms.hhs.gov/pqri  

Resources

Federal  Register. November 19, 2008. Volume 73, Number 224. Government  Printing Office. Washington, DC.  [Online].  Available at    http://edocket.access.gpo.gov/2008/E8-26213.htm (last visited April 21, 2009).   

 

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