New Year’s Eve is a time to celebrate transformation and positive change—and for that, it’s one of my favorite holidays. Not only are you celebrating the year that’s gone past—from your best moments to your trickiest trials—but you’re also celebrating the year that’s about to come. It’s a time for new beginnings, and it’s the perfect moment to evaluate your life’s trajectory and adjust course.
But, as fun as it is to talk about personal aspirations and symbolic opportunities for change, we can’t exactly leave it at that. (This isn’t Buzzfeed, after all!) The new year ushers in more than an annual chance to make new resolutions and commitments; it also presents some tangible business opportunities and the chance to prepare for a financially tenebrous future. (Do you see where I’m going with this, yet?) It’s a new year; it’s a new Merit-Based Incentive Payment System (MIPS) reporting period—and based on big changes coming to Medicare in 2020 (and beyond), it might be time for PTs to make a big change and participate in the program.
Last year, we asked therapists to wait and listen before diving headfirst into MIPS. We weren’t sure the juice was worth the squeeze, and we didn’t want to get folks locked into a burdensome program that had no promise of a big return. Well, we waited, and we listened—and with the Centers for Medicare and Medicaid Services’s (CMS’s) looming reimbursement changes, we’ve realized it’s time to take a closer look at MIPS participation. We still can’t tell you what the right choice is for your particular clinic, but there might actually be some serious benefits to participating this year.
1. You could squeeze more money out of CMS.
This is the biggest, most notable benefit to participating in MIPS this year. CMS is queuing up two major cuts to rehab therapy reimbursements: the PTA and OTA payment reduction and the industry-wide 8% cut. These cuts may not take effect for another year (or two, depending on which one we’re talking about), but if you want to try to mitigate them with extra MIPS income, then you need to prepare to participate in the program ASAP. After all, it takes a little time to reap the rewards—or penalties—of MIPS (e.g., your 2020 MIPS score determines your 2022 adjustment).
It should, in theory, be possible to earn a little more MIPS money this year compared to years prior. CMS increased the base adjustment bonus to 9%—which means if you perform well, you could theoretically receive up to a 9% positive adjustment to all of your Medicare Part B reimbursements. Plus, the additional bonus for exceptional performance is sticking around; so, if you earn an exceptionally high score (i.e., you earn 85 or more overall points) you could earn a 0.5% to 10% positive adjustment on top of your base adjustment.
A Word to the Wise
Remember, none of these adjustments are guaranteed. Because MIPS is a budget-neutral program and the payment incentives are fully dependent on the failure of other providers, it seems highly unlikely that high-performing participants will receive the full 9% positive adjustment. MIPS participants are simply doing too good of a job.
In 2017, 93% of MIPS participants earned a positive adjustment, and the maximum recorded adjustment (including the additional bonus for exceptional performance) was 1.88%. MIPS participants performed even better in 2018: 98% of all participants earned a positive adjustment, with a maximum recorded adjustment of 1.68%. While this is a far cry from 9%, it’s better than nothing—and if you play your cards right, you might be able to take some of your money back from CMS.
2. Participating in MIPS now could help you prepare for the program’s future.
Just like the wider universe, MIPS has expanded a little bit each year since its genesis, encompassing more providers vis-à-vis tweaks to the low-volume threshold and the list of eligible providers. Some compliance experts even predict that MIPS participation could be mandated for all providers in the not-too-distant future. That isn’t a fact that we can absolutely confirm, but it might not be a bad idea to take this prediction into account when considering participation. It may behoove you to get ahead of the game and familiarize yourself with MIPS instead of waiting until you’re required to report.
Besides, we do know for sure that MIPS will be a little more forgiving in 2020 than it will be in 2021. The performance threshold is slated to rise another 15 points after this year, and some compliance experts (Rick Gawenda, specifically) are predicting that CMS will raise the threshold again in 2022. If you get in when the stakes are lower and learn the rules of the game, you’ll likely have an easier time earning a positive adjustment than someone who comes in on round four.
3. You could use MIPS as an opportunity to improve the quality of your clinic’s services.
People give CMS a lot of flak for its attempts to change the healthcare industry—and sometimes rightfully so. But at the end of the day, MIPS (as inelegant and cobbled together as it may be) is still a genuine attempt to improve the patient experience and hold healthcare providers to a higher standard.
I mean, just take a look at the quality category: CMS is requiring therapists to submit at least one outcomes measure—and it offers incentives for those who choose to submit more than one. Tracking outcomes is a wonderful evidence-based practice that helps providers measure and improve a treatment’s effectiveness. We’re huge fans of outcomes tracking over here at WebPT, and we think every clinic should do it—MIPS or no MIPS.
Healthy Healthcare Habits
Outcome measures aren’t the only half-decent tool CMS is using to improve the healthcare industry—you only have to look as far as the improvement activities category to see that. Not all improvement activities are winners, but some of them encourage really great medical practices. In 2019, therapists could complete improvement activities requirements by educating patients, implementing fall screening programs, employing evidence-based treatments, strengthening the local community’s health programs, supporting chronically ill patients, and assessing their clinic’s patient experience—just to name a few. I would argue that these practices could unilaterally improve a clinic.
If providers stop looking at MIPS as a necessary evil and see it as a real opportunity to grow, it could be a great way to pick up some good habits that could seriously level-up your practice.
4. MIPS could help the rehab therapy industry grow.
As it currently stands, rehab therapy is facing a pretty serious dearth of data. CMS wants to know which healthcare interventions are effective and cost-efficient so it can incentivize those specific treatment paths. The irony, of course, is that rehab therapy is sitting right under CMS’s nose—but the agency doesn’t have enough data to demonstrate, beyond a shadow of a doubt, that rehabilitative therapy is a cheaper, more cost-effective alternative to invasive or dangerous treatments (e.g., surgery or opioids).
MIPS could be the perfect avenue for rehab therapists to show CMS the true value of their services. And, if therapists want to reduce (or even revert!) the upcoming industry cuts, playing nice with CMS and willingly offering up this information might be the best route to take.
5. Reporting could be less burdensome than ever before.
MIPS reporting is more than a little intimidating. It can be incredibly complicated and difficult to navigate—especially if you don’t find the right tools. Luckily, WebPT is totally prepared to help you crush it in 2020 and earn those sweet, sweet incentive payments. Our MIPS solution lets you report quality measures directly from the EMR—and this year, we’ve worked with CMS to get WebPT’s rehab therapy-focused outcome measures officially approved for inclusion in the quality reporting category. (That means you no longer have to pay a separate charge for FOTO in order to successfully report with our MIPS solution!) Plus, our partner, Healthmonix, provides a dashboard where you can report your improvement activities and track your overall reporting progress throughout the year. Our goal was to make MIPS participation as easy as physically possible for ya.
So, it’s a new year, new you. Are you ready to change up your workflow and take the MIPS leap of faith? Tell us your plans in the comment section below.