Over the past several years, Medicare and commercial payers have moved toward value-based payment, shifting from payment solely based on the volume of care, such as traditional fee-for-service, to payment more closely related to outcomes of care. Value-based payment models use measures of quality and cost to determine payment for providers. Ensuring high quality of care while controlling cost is key to success in these models. Physical therapists need to be able to use quality measures to articulate the value they bring to the health care system, given that in the near future payment for services will depend on quality-measure performance.
A variety of programs have been developed to address value-based care payment, including the Medicare Quality Payment Program (QPP).
Starting in 2019, the Centers for Medicare and Medicaid Services (CMS) is requiring certain PTs and physical therapy practices to participate in QPP through the Merit-based Incentive Payment System (MIPS) OR Advanced Alternative Payment Models (APMs).
Certain PTs in private practice will be required to participate in the QPP program through either MIPS or Advanced APMs beginning January 2019. Additionally, CMS has proposed to allow certain other PTs and physical therapy practices to opt in to the program, enabling them to earn incentive payments and to prepare for participation in Advanced APMs. Learn more
Eligible clinicians will be subject to a performance-based payment adjustment through MIPS. Learn more
Clinicians may earn a Medicare incentive payment if they participate successfully in an Advanced APM or innovative payment model. Learn more
Over the past several years, Medicare and commercial payers have moved toward value-based payment, shifting from solely payment based on the volume or care, such as traditional fee-for-service, to payment more closely related to outcomes of care. Value-based payment models use measures of quality and cost to determine payment for providers. Ensuring high quality of care while controlling cost is key to success in these models. Physical therapists need to be able to use quality measures to articulate the value they bring to the health care system, given than in the near future reimbursement of services will depend on quality-measure performance.
Understanding the Value of "Value-Based Care"
APTA's program director of quality, Heather Smith, PT, MPH, explains the evolution of value-based care and what PTs, PTAs, and students need to know.
Listen to the podcast.
Physical Therapists: The Value We Bring
What is APTA doing? Recognizing the health care payment shift toward value, APTA in 2013 approved funding for the Physical Therapy Outcomes Registry (Registry). The Registry uses data from the profession, for the profession, to help you elevate your patient care, visualize your value, and define your future.
The Registry provides information that physical therapists (PTs) can use to improve the quality and safety of the care they provide to their patients and clients. For example, the Registry can help PTs assess their compliance with evidence-based clinical practice guidelines. The Registry can provide information about outcomes of care, and PTs will use it increasingly within value-based payment models to ensure that payment is adjusted based on the quality of care provided.
APTA formalized a quality measure portfolio for PTs in 2016, which is a list of measures that are relevant to physical therapist practice. The initial portfolio includes many of the measures that PTs report in Medicare quality-reporting programs; however, more meaningful measures are needed as we transition to value-based payment. APTA is working to develop additional physical therapy quality measures. In the future, the same quality measures used for payers may also be used for our patients in the future to allow them to make more informed decisions about their care.
APTA coding reform efforts, specifically the creation of tiered evaluation and reevaluation CPT codes, also play an important role in our shift to value. The new evaluation codes reflect 3 levels of patient presentation—low, moderate, and high complexity. The tiered evaluation codes will allow us to more accurately identify the complexity of our patients and will be used in determining payment in alternative payment models in the future. For more information on these codes see our website.
What Can You Do?
Many PTs already report quality measures, some of which might be reported by the facility. Identify the quality measures that are relevant to your practice—the PT measure portfolio is a great resource to identify those measures. If you are not already collecting data in your facility or practice, you can begin by collecting 1 or more of the PT-specific quality measures included in the physical therapy measure portfolio. The registry can assist you in data collection, using data from your EHR. If you want to be part of the Registry, contact the Registry staff directly.
Quality Measures and Physical Therapists
Physical therapists may participate in quality reporting and the collection of quality data in different ways depending on their practice setting. In facility-based settings such as acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and outpatient facilities, PTs contribute to facility-wide quality measures. For example, the change in a patient's mobility from intake to discharge in a post-acute care setting reflects the gains in mobility from the cumulative interventions of the care team. For PTs in private practice, quality measures are structured to measure the impact of the individual practitioner; for example, assessment of pain on initial evaluation using a standardized pain assessment.
Only a limited number of quality measures at the individual PT level assess the outcome of interventions (see Quality Measure Resources below). Moving forward, as value-based payment models continue to expand, APTA's goal is to ensure development of appropriate quality measures that demonstrate the value of physical therapy, and to advocate for the inclusion of those quality measures in value-based payment models.