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In January, Medicare payment for outpatient services is expected to move dramatically toward value-based payment. Physical therapists (PTs) and other providers likely will be added to the provider types that must participate in Medicare's Quality Payment Program (QPP). The impact on physical therapy? An estimated 55,200 physical therapists (as of 2016)1 in noninstitutional settings who bill Medicare Part B for outpatient services will be eligible to participate in QPP.

QPP

The plan, included in the Centers for Medicare and Medicaid Services's (CMS) proposed Medicare physician fee schedule rule for 2019, would require certain PTs, occupational therapists, social workers, and clinical psychologists to participate in QPP after having been excluded for the first 2 years of the program.

The goals of QPP, CMS says, are to improve beneficiary outcomes, reduce burden on clinicians, increase adoption of and maximize participation in Advanced Alternative Payment Models (Advanced APMs), improve data and information sharing, ensure operational excellence in implementing programs, and deliver technology capabilities that meet users' needs.

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  1. MDCR PROVIDERS 6 Medicare Providers: Number of Medicare Non-Institutional Providers by Specialty, Calendar Years 2012-2016. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-reports/CMSProgramStatistics/2016/Downloads/PROVIDERS/2016_CPS_MDCR_PROVIDERS_6.pdf. Accessed July 1, 2018.
  2. CMS2016 Reporting Experience, Including Trends (2007-2016), Physician Quality Reporting System, Appendix. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html. Accessed August 30, 2018.

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