• Value-Based Healthcare in the Therapy Clinic

    September 18, 2017 | Kevin Kasmar

    For therapy practices, the physician quality measurement program has evolved in 2017. Earlier in the year, therapy practices were able to stop reporting PQRS (Physician Quality Reporting System) measures. This happened not because things are getting easier, but because it is – once again – time for a change in the healthcare payment systems. The future for Medicare and the commercial payers is to reward clinicians for the value of their work by:

    • improving the quality of care
    • lowering costs to payer and patient
    • increasing patient access.

    To meet these goals there will be significant changes. Once such change is MACRA (Medicare Access and CHIP Reauthorization Act), which includes MIPS (Merit-Based Incentive Payment System) and APMs (Alternative Payment Models).

    2017 MIPS Quality Measures

    Although MIPS is similar to PQRS in the method of reporting, there are significant differences. MIPS’ intent is to combine current efforts and improve outcomes by including measures that embrace:

    1. Quality
    2. Improvement Activities
    3. Advancing Care Information
    4. Cost

    As of today, therapists are not required to start reporting until 2019. Unfortunately, this stall can cause complacency and may be detrimental to the overall health of a clinic. To ensure success, starting now to learn more about this program is essential. Since there are more components, research into the new reporting codes and using 2018 to test your plan will keep your practice on track.


    The alternative payment models (APMs) that are currently proposed are not conducive to the current out-patient physical therapist. During the next few years, CMS (Centers for Medicare and Medicaid Services) and APTA (American Physical Therapy Association) will be working toward better payment models that will allow for participation. The goals for the program are to:

    1. base 30% on Medicare fee-for-service by year-end and increase it to 50% by the start of 2018
    2. include outcome measures in 90% of payment decisions by the end of 2018

    Working together with other facilities and providers is the core function of these models. You’ll need to do in-depth research before committing to ensure the plan has the right payment for your particular clinic. To learn more about APMs, take a close look at the APTA’s contracting guide and the CMS APM track information.

    Fee-for-quality is the wave of the future

    It’s imperative to keep the physician quality measurement program front and center in your clinic’s future plans. MIPS is something that everyone can work toward right now, even though it is not required. CMS has a website dedicated to quality payments and should be the starting point for all of your decisions. We also recommend the APTA’s MACRA FAQs page to increase your QPP (Quality Payment Program) knowledge. Start today, to prepare for your clinic’s future.