Medicare payment is poised to change in big ways for physical therapists (PTs) in private practice. Are you ready?
APTA can help. Since late 2015, the association has been rolling out new resources to help members prepare for what's coming down the pike as the US Centers for Medicare and Medicaid Services (CMS) implements its Quality Payment Program (QPP). The program already is significantly changing how some health care providers report to Medicare, and those changes likely will be required of PTs in the near future.
The association's latest offering: a 4-minute video featuring Heather Smith, PT, MPH, APTA's director of quality, on reporting through MIPS and APMs, 2 of the biggest changes to how CMS will be doing business.
Don't miss the video. But before you do, take this quick PT in Motion News quiz to find out just how much you know about what's happening. Consider it a kind of warm-up exercise—answers are at the bottom of this quiz. Also check out another quick questionnaire that looks at your readiness for payment reform in general.
1. What does MIPS stand for?
A. Meta-Inquiry on Performance Statistics
B. Medicare-Implemented Payment Scale
C. Madness-Inducing Participation Structure
D. Merit-Based Incentive Payment System
2. Successful participation in Advanced Alternative Payment Models (APMs) could result in a lump sum additional payment each year of how much?
A. An amount equal to 2% of the previous year's fee-for-service payments
B. An amount equal to 3% of the previous year's fee-for-service payments
C. An amount equal to 5% of the previous year's fee-for-service payments
D. An amount equal to 7% of the previous year's fee-for-service payments
3. How soon can PTs expect to be required to participate in QPP?
D. They are required to participate this year
4. Which MIPS performance category will include measures that were reported under the Physician Quality Reporting System?
A. Advancing care information
B. Improvement activities
5. How high will MIPS noncompliance payment penalties be by 2022?
6. True or false: clinicians participating in an advanced APM must continue to participate in MIPS.
7. True or false: the Comprehensive Care for Joint Replacement model is considered an APM.
8. To qualify as an approved APM, a program must require at least 50% of eligible clinicians to use certified electronic health record technology during the first year. What percentage is required in the second year?
9. How can the APTA Physical Therapy Outcomes Registry help PTs participate in QPP?
A. Participation in the Registry earns PTs points toward MIPS improvement activities.
B. The Registry can package data for submission to MIPS.
C. PTs are able to receive real-time feedback on their performance throughout the year.
D. All of the above.
10. True or false: QPP changes will be limited to only Medicare Part B for the forseeable future.
1. Answer: D. It's the Merit-based Incentive Payment System, and although the change might spark the fear of madness among PTs, things may not be as dire as all that: PTs who report to PQRS already know how to do much of the quality reporting required by MIPS, and PTs can voluntarily participate in MIPS risk-free this year so they can hit the ground running when QPP participation becomes a requirement.
2. Answer: C. When APMs succeed in reducing providers’ spending, they may receive a payment equal to 5% of the previous year's payments. The payments will be made 2 years after the performance period being evaluated.
3. Answer: B. While not certain, there is a strong likelihood that PTs will be required to participate beginning in 2019.
4. Answer: D. Data previously reported under PQRS will be included in the Quality category. The Cost category will contain new measures still being worked out by CMS; Improvement Activities will include elements such as practice access, population management, care coordination, and beneficiary engagement; and Advancing Care Information encompasses the former electronic health records (EHR) "meaningful use" program under PQRS. Although PTs weren't required to participate in the meaningful use under PQRS, they will be required to do so under MIPS—meaning if you haven't established a relationship with an EHR program, now would be a good time to start.
5. Answer: C. CMS is not playing around. Penalties for noncompliance could be as steep as 9% by 2022.
6. Answer: False. Clinicians can choose to participate in QPP either through MIPS or through participation in an APM—they don't have to do both; in fact, they have to choose 1 or the other.
7. Answer: True – for the most part. One of the CJR tracks is an APM, along with several others listed on the CMS Centers for Medicare and Medicaid Innovation webpage.
8. Answer: D. At least 75% of eligible clinicians must use certified EHR technology by the second year of operation.
9. Answer: D. APTA's Physical Therapy Outcomes Registry is a storehouse, a data packaging service, and an ongoing feedback loop all in 1.
10. Answer: False. Look for QPP provisions to spread to private payers—and probably sooner than you think.