Why you get screened at your PCP: the measure counts every patient over twelve

Significant findings

If you have wondered why the tablet asks about your mood at an appointment for something else, this is the rule. Quality ID 134, "Preventive Care and Screening: Screening for Depression and Follow-Up Plan", is a process measure in the Merit-based Incentive Payment System. Its description: the "Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter."

The specification names the Patient Health Questionnaire (PHQ-9) and the PHQ-2 among acceptable adult tools. It defines the plan: "Documented follow-up for a positive depression screening must include one or more of the following: Referral to a provider for additional evaluation and assessment...; Pharmacological interventions; Other interventions or follow-up for the diagnosis or treatment of depression." A referral counts. A prescription counts.

The specification also carries its own caution, which is worth quoting back to anyone who moves fast: a clinician should "Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation." Its rationale section cites the claim that primary care physicians "fail to recognize up to 46 percent of depressed patients."

Worth asking

The measure is met by the screen and the documented plan, not by whether you got better. That is what a process measure is. Whether the screen leads to a conversation or to a code is the thing the rule cannot see and you can.