By and large, Medicare’s 2016 Final Rule was underwhelming—and for most of us (including me), that probably warranted a big sigh of relief. But while there are no major changes on deck for this year, one thing that definitely should have caught your eye if you perused our Quick Guide to the 2016 Final Rule was the verbiage alluding to the future of PQRS—specifically, the possibility that PQRS reporting as we know it could cease to exist in 2017.
Now, those of you who never participated in PQRS—either because you don’t treat a lot of Medicare patients or you decided the 2% payment reduction penalty wasn’t enough to justify the time and effort satisfactory reporting requires—probably reacted to this revelation with a sly smile and a satisfied pat on your own back. “Good thing I never bothered with PQRS; it’s going away forever anyway!” I imagine all you PQRS-avoiders saying. Well, I hate to break up your celebratory revelry, but it’s a bit short-sighted. Because while the standalone PQRS program might fall to the wayside, Medicare’s requirements for quality data-reporting—as well as the associated financial consequences—are only going to intensify. Enter the Merit-based Incentive Payment System, otherwise known as MIPS.
In 2017, Medicare will roll out MIPS, which is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS will replace PQRS as well as Meaningful Use and the Value-Based Payment Modifier (two programs for which rehab therapists were never eligible). As we explained in our Quick Guide, MIPS will use the basic infrastructure (i.e., the measures and data analysis mechanisms) associated with the old programs, but will apply the results in a different way. Essentially, MIPS rolls all of these quality data-reporting requirements into one mega-program. If that sounds pretty intense, it’s because it is. The good news is that Medicare is taking a slow-roll approach to MIPS, which means rehab therapists likely won’t have to start fulfilling MIPS reporting requirements until 2019.
Did I hear another collective sigh of relief? For all you anti-PQRSers out there, this day just keeps getting better and better: this coming year could be the last for PQRS, and rehab therapists won’t need to participate in the new, more intense program until 2019? That’s two years of sweet reprieve from Medicare!
But, don’t bust out those balloons and noisemakers quite yet, because there are still a lot of “ifs” to contend with. For one, if Medicare’s history has taught us anything, it’s that the Final Rule can change dramatically every year, which means PQRS could very well keep on chugging for years to come—with the penalties getting progressively steeper along the way. Furthermore, why on Earth would you rest on your laurels when it comes to data reporting?
And that brings me to the main point of my post today: data is everything. If you want to not only ensure your own survival in a pay-for-performance world, but also improve the outlook—with respect to payment, patient care, and influence within the healthcare space—for the rehab therapy profession as a whole, you must collect and utilize data. The fact that PTs, OTs, and SLPs won’t be eligible for MIPS right off the bat indicts our current position within the healthcare food chain. It implies that we don’t matter like physicians matter, and that’s bull. We know that the positive impact we make in the lives of our patients should be shouted from the rooftops. And if the masses knew about—and understood—that impact, rehab therapists would be the most in-demand healthcare providers in the country. Unfortunately, though, knowledge of rehab therapy isn’t as widespread as it should be—and for the most part, we remain subsequent care providers, with the majority of our patients funneling in from physicians and surgeons.
Have you ever stopped and wondered why that is? It’s not because government agencies and insurance companies like physicians and surgeons more than they like us, nor do payers automatically assume those providers do the best jobs. It’s because of data. These types of providers have gotten way out in front of us with their use of historical and registry data “proving” the efficacy of their treatment—and that has allowed them to achieve validity, value, and power.
I know we all just want to treat our patients; the analytical and business work that goes with it doesn’t come naturally to us. But, at the end of the day, you’ve got to make money to keep your practice operating—and thus, to continue treating your patients. You’re kidding yourself if you say payments don’t matter. Every private practice owner wants more money, more patients, and more respect within the healthcare community. Every therapist wants to demonstrate worth. Data is the key to achieving those things, and if you’re not collecting, analyzing, and sharing that data, you’re hindering your practice and hurting your profession.
Data is our path to greatness; it allows us the opportunity to earn our rightful place among other “primary” healthcare providers. And while performing outcomes or PQRS can be a pain-in-the-you-know-what, it’s worth the effort when done correctly. Not only will it prepare you for MIPS—or whatever other reporting programs lay in wait—but it also gets you and your practice on the road to amassing and sharing data sooner rather than later. Whether you’ve been PQRSing for years or PQRStinating the whole time, you better jump on the bandwagon now. Otherwise, you’re putting your future at risk. You better believe physicians groups, chiropractors, and hospitals have been reporting on PQRS measures since the beginning (mainly because they were incentivized to do so, but regardless, the data is there). They might have a pretty good head start in terms of data collection, but there’s still time to catch up. Don’t get left in the dust; don’t let them win the value game without a fight. Get out there, collect and report data, and prove your—and your profession’s—worth.