Notes From the Field: MIPS, Quality Improvement, and the Physical Therapy Outcomes Registry
Like many physical therapy clinics, Columbus Orthopaedic Clinic and Outpatient Center in Columbus, Mississippi, has had to make difficult decisions regarding whether—and how—to include physical therapists in the Merit-based Incentive Payment System (MIPS). Columbus is a multispecialty practice focusing on orthopedic surgery, sports medicine, and rehabilitation, employing 11 PTs and 6 PTAs between 2 clinical sites.
#PTTransforms Blog spoke with staff physical therapist Peyton Fandel, PT, DPT, who played a key role in evaluating the potential benefits of MIPS and enrollment in the APTA Physical Therapy Outcomes Registry.
#PTTRANSFORMS:What was the genesis of Columbus Ortho's participation in MIPS and the APTA Physical Therapy Outcomes Registry?
Peyton Fandel: Angela Pendas, our CEO, had already been working with MIPS with Columbus Ortho's physicians, who were required to participate. In 2018, she tasked me with finding out what would be happening with MIPS with regard to PTs. I looked for MIPS information from APTA, which led me to the Registry.
#PTTRANSFORMS:Were you required to participate in MIPS?
PF: In 2018 we were not, but we did so voluntarily, because the incentive payment was attractive. If our data looked good, we could get up to a 7% increase in reimbursement from Medicare. We also were thinking about what MIPS might look like in 2019.
#PTTRANSFORMS:Why did you decide to enroll in APTA's Registry?
PF: To participate in MIPS, we needed to track data and make sure we were reporting things directly to CMS with as little work as possible. We asked ourselves, was it necessary that we find a registry? And if we did, which registry do we need to be a part of? There weren't very many when we first started the process.
What distinguished the Physical Therapy Outcomes Registry was APTA's voice as the national association representing physical therapy, whether in Washington or on the state level. APTA always seems to get new information first and relay that as quickly as they can. We knew that APTA would have a leg up on anybody else. We were comfortable knowing that if APTA is going to be doing it, they're going to be doing it right.
#PTTRANSFORMS:Was it an easy process getting clinician buy-in with the Registry?
PF: It was an easy process for us. Once everybody saw the different benefits, they were really on board with it.
For anybody who's having trouble getting their clinics to buy in, I think there are some important benefits to consider. From a data collection standpoint, the Registry helps save time and energy. From a business standpoint, it's good to be able to objectively look at your patient care and compare it with other clinics. For example, we can look at outcomes clinic by clinic, or therapist by therapist. We can find out where we need to improve in order to excel. The Registry also helps to direct certain patients with a particular condition, like a shoulder injury, to a certain therapist who, according to their outcomes data, is really good at shoulder rehab.
I think marketing to patients and payers is where you're going to see a lot of help from the Registry. We can show patients how we're performing, because we've got it on paper. Patients will appreciate it, as well as insurance companies and other third-party payers.
#PTTRANSFORMS:What were your outcomes like for MIPS activities for 2018? Were you surprised?
PF: In 2018, our quality measures were really good, although that year was a learning process. In the first 2 quarters we were still trying to figure out what we needed to report, and how the Registry worked. Once we enrolled in the Registry, we started getting a little bit more clarity as to where our documentation needed to improve. It helped us get all of our therapists at the 2 different locations on the same page.
In quarters 3 and 4, our quality measures were much better. It was fun to see the transformation from having somewhat of an idea of what we're supposed to do, but not really knowing how to do it, to saying, "We've got this figured out."
I wasn't surprised at our final outcomes, because I think our PTs are some of the best, but it was comforting to see on paper that we are doing things correctly.
#PTTRANSFORMS:Did your use of APTA's Registry affect or change the way you treat patients?
PF: We've always tried to get patients better faster, in a manner that is effective and promotes patient independence. From what we learned through the Registry, we've changed our patient education to explain not just what you, the patient, need to do, but why you need to do it. It helps patients understand their injuries and communicate better with PTs about specific trouble they are having.
Better communication also builds their trust. In return, we get not just better objective outcomes, but also better subjective outcomes. The Registry helps us say, this is what they said they want, and this is what they said they have trouble with. It helps both patients and payers see that we're treating the patient, not just the problem.
#PTTRANSFORMS:What is the business value of the APTA Physical Therapy Outcomes Registry, from your perspective?
PF: Once you start collecting a lot of data, it helps set your therapists apart. The Registry helps you see objectively where you might be lacking and where you might excel. Sometimes I think we can get blinded—we all think that our way's the right way and that we've gotten every patient better. I think it benefits us to see that there may be a different way. A therapist might be doing something different that might help our outcomes.
Sometimes we need to take a step back and look at things from above the ground and see that one therapist over here seems to be getting patients a little bit better, a little bit quicker, or that another therapist is really good with low backs, or that I may not be as good as others at treating shoulder problems. The data that the Registry will collect will help us better direct patient care, as well as identify continuing education needs.
As more practices participate, this will be the case on a broader level. Competition drives success. We all strive for perfection, and anytime you see that somebody may be outdoing you, you try to do better. I think that's good.
I'm a Mississippi state fan, so it's not fun to watch Alabama win national championships, but that's okay. That means we keep on striving, right?
#PTTRANSFORMS:Looking ahead, do you have any thoughts on business planning and implementing technology like APTA's Registry?
PF: The way health care is moving more to a data-oriented reimbursement model, I would look very hard at using an EHR. More and more documentation is going to be necessary. Practices need a secure and efficient way to collect and transcribe patient data, and an EHR is probably the best tool for that. Obviously, it's easier for the Registry to integrate with an EHR because it's pulling from there.
Our EHR was not associated with the Registry at first, and the Registry did a good job of integrating with our EHR even though it was a little bit complicated. Our therapy documentation is on one system that then gets integrated into the EHR, which is a separate system, and then transferred to the Registry. A couple of times we had some trouble with data pulling from our EHR over to the Registry. Everyone that's involved in the Registry at APTA has been open and honest, and has been on top of making sure they get things correct. Anytime a group takes each person seriously and tries to fix everybody's problems, I think that's huge.
#PTTRANSFORMS:What would you tell someone who is on the fence about joining the APTA Physical Therapy Outcomes Registry?
PF: If someone is questioning whether or not to join a registry or specifically APTA's Registry, just know that it is a great source of information, and that you become part of another community—not just within your region or your profession, but in a community as a whole where everybody's striving for the same goal. That helps to improve and advance the physical therapy profession within health care more broadly.
For more information about the Merit-based Incentive Payment System (MIPS), check out APTA's previous blog posts on key MIPS deadlines and answers to common MIPS questions. For more information about enrolling in the Physical Therapy Outcomes Registry, contact firstname.lastname@example.org.