After months of heated debate and public commentary—much of it coming from physicians who felt they needed more time to prepare themselves to participate in a brand-new quality reporting program—the Department of Health & Human Services (HHS) on Friday released its final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This act, which will go into effect January 1, 2017, reimburses eligible Medicare physicians based on the quality of care they deliver through the government’s Quality Payment Program, which replaces the Sustainable Growth Rate (SGR) formula for physician reimbursement.

MACRA’s flagship program—the one specifically focused on quality data reporting—is the Merit-based Incentive Payment System (MIPS). It replaces the Value-Based Payment Modifier (VM) program, which allowed for differential Medicare payments based on the quality and cost of care provided. Rehab therapists were never eligible to participate in the VM program. However, rehab therapists (e.g., PTs, OTs, and SLPs) were eligible to participate in PQRS—and as we’ve outlined in previous posts, MIPS is replacing PQRS, too.

So, PTs, OTs, and SLPs were eligible for PQRS but not VM, and now MIPS is replacing both. And that has left rehab therapists wondering where they stand now with respect to quality data-reporting. Here’s the situation:

The State of Rehab Therapy in 2019 Guide - Regular BannerThe State of Rehab Therapy in 2019 Guide - Small Banner

Rehab Therapists Aren’t Eligible for MIPS—Yet

The rule was “informed by a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments.” Interestingly, while many physicians resisted implementation of this outcomes-based program, much of the commentary received from those in the rehab therapy space urged CMS to reconsider its decision to exclude certain specialists—including physical therapists, occupational therapists, and speech therapists—from the program during its first two years. As noted on page 126 of the final rule, “One commenter indicated that it is feasible to include physical therapists in the expanded definition of a MIPS eligible clinician given that physical therapists have been included in PQRS since 2007. The commenter noted that there will be a negative impact on the quality reporting rates of physical therapists if they are excluded from MIPS in 2017 and 2018.” And as we reported this past spring, that could have serious financial implications for rehab therapists in future years: “MIPS represents one more step toward tying virtually all Medicare payments to some type of value measure, which begs the question: if rehab therapists aren’t allowed to participate, how much of the payment pie will they miss out on?”

But, PTs, OTs, and SLPs Can Participate in MIPS Voluntarily

In response to concerns over the lapse in quality data reporting rehab therapists will experience during the first two years of the MIPS program, CMS indicated that it will allow non-eligible providers to participate in MIPS on a voluntary basis during the 2017 and 2018 reporting years. This might seem like an inconsequential compromise, but it actually could have a major impact on the rehab therapy community—especially if it draws high voluntary participation levels. Here’s why:

  1. It allows therapists a chance to maintain continuity in their quality data-reporting habits.
  2. It provides therapists with a no-pressure opportunity to learn the ins and outs of MIPS reporting—without the threat of a negative payment adjustment hanging over their heads.
  3. It gives therapists the benefit of entering the third reporting year—during which they will, as CMS has suggested, be considered eligible providers—feeling much more confident than their physician colleagues, who do not have the option of voluntary participation right off the bat. As CMS states in the final rule, “We do intend however to provide informative performance feedback to clinicians who voluntarily report to MIPS, which would include the same performance category and final score rules that apply to all MIPS eligible clinicians. We believe this informational performance feedback will help prepare those clinicians who voluntarily report to MIPS.” Talk about getting a leg-up.

Stay tuned for more information on the specifics of rehab therapists’ voluntary participation in MIPS as well as details on any additional payment reform initiatives the CY 2017 Medicare Physician Fee Schedule Final Rule—which we expect CMS to release later this month—holds.

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