CMS Proposes 2018 Quality Payment Program Rule: Here’s What PTs Need to Know

CMS Proposes 2018 Quality Payment Program Rule: Here’s What PTs Need to Know

The US Centers for Medicare and Medicaid Services (CMS) may have slowed down the pace at which it is implementing the move toward quality-based payment, but that doesn’t mean physical therapists (PTs) should be taking a business-as-usual attitude.

With the release of its 2018 proposed rule for quality payment, CMS is taking some of the pressure off clinicians and groups with smaller practices or low numbers of Medicare patients to meet Merit-Based Incentive Payment System (MIPS) requirements. Still, the shift away from fee-for-service models continues, and even though PT participation in MIPS is still voluntary next year, it’s almost a given that PTs will be mandatorily included as early as 2019.

Details on the proposed rule are available from CMS, but here are a PT’s 4 most important takeaways:

Get involved in alternative payment models (APMs) now. Participating in an advanced APM could give you a 5% incentive payment with every year of successful participation. CMS offers a webpage specifically devoted to learning more about participating in APMs.
APMs: They aren’t just about Medicare. Don’t limit your participation in APMs to only Medicare-based programs. According to CMS, beginning in 2019—the year PTs could be required to participate in MIPS—becoming a qualified provider through the “all payer combination option” will require the provider to participate in APMs with both CMS as well as an “other payer.”
Take MIPS for a test drive. PTs aren’t formally included in MIPS, meaning reporting scores won’t yet affect future payment adjustments. But you can report under MIPs voluntarily, which will help prepare you for future years when PTs are likely to be required to participate.
Get with the technology. As health care moves to outcomes-based payment, it will be critical for PTs to have access to real-time clinical data to understand how they perform, identify areas to improve quality, and manage patient populations. Without data physical therapists will be unable to receive future incentive payments. APTA’s Physical Therapy Outcomes Registry will have the ability to extract information from electronic health records, allowing your clinical data to be readily usable and actionable.

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