If you’re like most physical therapists, you’re probably planning to participate in the Merit-based Incentive Payment System (MIPS) beginning in 2019. As we’ve explained in earlier posts, nearly all private practice PTs can take part in MIPS, even if their Medicare patient load is relatively small; and almost every PT has good reason to do so, especially given the trends in healthcare reimbursement. With a payment structure rewarding quality care and patient engagement—two pillars of professional practice physical therapists know well—MIPS is both a path to better revenue and an easy onramp to value-based care. A lot of PTs have been wondering how to navigate the shift away from fee-for-service by Medicare and other payers. Their best first step, with MIPS now an option, is to do everything necessary to participate in the program successfully.

So, what should you do to ensure that your MIPS experience goes as smoothly as it possibly can? For one, it’s important to understand how MIPS payment adjustments work, and especially how your “Quality” and “Improvement Activities” scores can cause those payments to go up or down. And you should understand how leveraging certain tools—like a qualified clinical data registry (QCDR) integrated with your EMR and patient engagement solution —can help you meet the program’s various reporting requirements. We conducted a survey last September that found many PTs who are planning for MIPS haven’t considered how automated reporting tools might facilitate participation in the program.

What follows is a quick review of the MIPS performance categories that will apply to physical therapists in 2019, and then a closer look at how reporting tools are going to prove critical to MIPS success.

Performance Categories: An Overview

While CMS has established four performance categories that factor into MIPS scoring, just two concern therapists in 2019: Quality Measures and Improvement Activities. Your Quality Measures score will account for 85 percent of your total MIPS score and will be determined using reported measures assessing “health care processes, outcomes, and patient care experiences.” Your Improvement Activities score, which is intended to measure success in activities like the collection of patient-satisfaction data and the implementation of individual care plans, will account for 15 percent of your total composite score.

Under Improvement Activities, CMS has included “high-weighted” activities it considers more difficult to implement, and “medium-weighted” activities deemed easier to undertake. These “high-weighted” activities include, among others:

  • “Collection and follow-up on patient experience and satisfaction data on beneficiary engagement,”
  • “Engage Patients and Families to Guide Improvement in the System of Care,”
  • “Promote Use of Patient-Reported Outcome Tools,”
  • “Use of QCDR for feedback reports that incorporate population health.”

When it comes to reporting across these performance categories, MIPS therapists can do so in one of two ways: using claims submitted directly to CMS (you’ll attach quality data codes to your Medicare claims), or through their EMR and a qualified registry or QCDR.

Feeling lost in a fog of MIPS terminology? Download our MIPS glossary to gain a better understanding of its common and not so common terms.

Download Glossary

Using Reporting Tools to Your Advantage

Due to the many components of MIPS, it’s important that you choose a vendor that provides a one-stop shop for MIPS success as it’s not efficient to use different vendors for different categories. Here are five ways reporting tools and a single end to end solution in your clinic can help you succeed in MIPS.

  1. Reporting tools provide an all-in-one solution.

    To submit data on Improvement Activities, therapists who otherwise report using claims (and aren’t connected through a registry or QCDR) must do so manually through the agency’s Quality Payment Program website. Those who use comprehensive, integrated reporting tools, on the other hand, have everything they need to handle data submission for Quality and Improvement Activities alike.

  2. Reporting tools can help you earn more points.

    Success in MIPS depends on how you score relative to other providers, so it’s important to earn points wherever you can. When it comes to reporting quality measures, CMS offers bonus points for “end-to-end electronic reporting,” where data is transmitted directly from the medical record to a qualified registry or QCDR.

  3. Reporting tools can improve efficiency.

    When reporting tools are integrated with your EMR, they should seamlessly populate patient data to facilitate outcomes reporting. Some have voiced concern that MIPS will prove overly burdensome for physical therapists. But when the MIPS reporting process is mostly automated, the main thing you’ll have to worry about is providing great patient care.

  4. Automated tools can improve reporting accuracy and maximize reimbursement.

    As with any healthcare reimbursement system, there are rules you have to follow when reporting for MIPS—and strategies you can use to improve your payment adjustments. When you leverage reporting tools that automatically pull data from your EMR, you’re far less likely to make mistakes that might have a negative impact on your MIPS score. And the opposite is also true: The more accurate and thorough your reporting is, the more likely you are to earn a boost to your bottom line.

  5. Reporting tools provide data you can use to do better—not only in MIPS, but also as a practice.

    Another big benefit associated with patient reported outcomes tools is derived from the information the technology can provide your practice. With claims-based MIPS reporting, it’s hard to know how you’re doing throughout the year because you don’t get your score until the end. But when you’re using an outcomes reporting tool that’s tied to your EMR and patient engagement solution—and thereby connected to your entire practice—you’re constantly aware of your performance against the benchmarks so you can make any changes necessary to improve.

Are you planning to use reporting tools during this first year of MIPS eligibility? If so, we’d love to hear your reasons why.


Leave a Reply

Your email address will not be published. Required fields are marked *