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How MIPS Value Pathways will Prove the Value of Rehab Therapy

As value-based care models take hold, the time is ripe for rehab therapists to position themselves as primary players in the movement toward delivering optimal quality and value in the broader healthcare ecosystem.

Physical therapists continue to fight an uphill battle to gain equality on the healthcare playing field—long considered ancillary providers rather than primary providers within the healthcare continuum. The profession is often misunderstood, undervalued and underutilized. In fact, only eight to 10% of those who could benefit from physical therapy actually seek it.

As value-based care models take hold, the time is ripe for rehab therapists to position themselves as primary players in the movement toward delivering optimal quality and value in the broader healthcare ecosystem. So far, this has been hard to do due to a lack of relevant data collection by insurance providers. But there is a light at the end of the tunnel. Here’s how MIPS Value Pathways (MVPs) may offer rehab professionals the chance to participate in value-based care initiatives.

An opportunity to demonstrate value

According to a 2016 report, low back and neck pain had the highest healthcare spending among 154 conditions to the tune of $134.5 billion. Yet a 2018 study found that when physical therapists are involved in the first line of care in treatment of low back pain (LBP), patients have lower utilization rates of high cost health services including emergency care, imaging, or orthopedic surgeons, as well as lower use of opioids compared to those who saw a therapist later in care or not at all.

Despite mounting evidence of its value, rehab therapy is still not the first line of treatment when it comes to pain management particularly when there are barriers to access. So why isn’t it the default first line of treatment? In part, because collecting outcome measures in rehab therapy is cumbersome and time intensive, largely due to a lack of incentivization.

Fortunately, the Centers for Medicare and Medicaid (CMS) are facilitating participation and change via the evolution of the Merit-based Incentive Payment System (MIPS) to MVPs The catch? By using MIPS Value Pathway and MVPs, therapists can demonstrate the impact of a PT-first approach. There isn’t a rehab-focused MVP available to therapists—yet.

The transition from MIPS to MVPs for rehab therapists

MIPS is a reimbursement model to pay clinicians for the services they provide to patients. It was initiated as a result of the Medicare access and CHIP Reauthorization Act (MACRA) of 2015 which required Medicare to start compensating providers based on the value of services they were providing rather than the volume of services they billed.

In 2019, physical therapists, occupational therapists, and speech-language pathologists also became eligible to participate in MIPS. Although most providers participating in MIPS are scored based on four performance categories, rehab therapists are only scored on Quality (85%) and Improvement Activities (15%). While this was a step in the right direction, it was much like fitting a square peg in a round hole, so to speak. The reporting system was originally designed to support the collection of data that was applicable to physicians. As a result, it was quite cumbersome for our specialty setting as it was not set up in a way that allowed rehab therapists to demonstrate their true value.

The newly-implemented MVP reporting aims to make MIPS easier for clinicians by creating subsets of grouped measures and activities related to particular specialties. Beginning in performance year (PY) 2023, clinicians can report their MIPS data by choosing an MVP, rather than through traditional MIPS or the Alternative Payment Model (APM) Performance Pathway. While there are 12 MVPs currently in use for the 2023 performance year, none are currently directly applicable to rehab therapists. The good news? This may change soon.

Musculoskeletal care and rehabilitative support as an MVP candidate

Among the few MVP candidates for the 2024 performance year is Musculoskeletal Care and Rehabilitative Support, the first MVP applicable to rehab therapy specialties. If adopted in its current version it will have 14 Quality Measures, including five IROMS quality measures, and 11 Improvement Activities—five high-weighted, five medium-weighted, and one activity for the “Implementation of Patient-Centered Medical Home model.” You can take a look at the full breakdown of what’s included in the proposed MSK MVP on the QPP’s MVP Candidate Feedback page.

If the Musculoskeletal Care and Rehabilitative Support MVP moves forward, then the program will collect and capture costs. This will allow CMS—and any onlookers interested in reducing costs while optimizing care—to see how much PT costs as well as the impact of PT overall. Data collected through MVPs will no doubt demonstrate rehab therapy’s value at scale and offer a holistic view of downstream cost savings. Its consolidation of metrics shows true comparisons and competitive advantages. By demonstrating a correlation between quality and cost, rehab therapists will finally have an opportunity to demonstrate the value of using PT before medications, surgery, or other invasive treatment options.

Like the MVP program itself, the MSK MVP might take a bit of adjustment to get to where rehab therapists want it to be. It’s worth showing up to the discussion, however, since it offers an avenue for rehab therapists to bring their true value equation to the table. It offers an opportunity to prove to the broader healthcare system the value of rehab therapy. Let’s support this useful program to demonstrate what we’ve known all along—PT is both beneficial and cost-effective!

Credit: Vitapix, Getty Images

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Susan Lofton

Susan Lofton is a physical therapist with 25 years of experience in clinical care, operations, and senior-level management. Susan has worked in multiple healthcare settings including acute, IRF, skilled nursing, home health and outpatient, giving her exceptional insight into the transitional needs of patients and the inner workings of the healthcare ecosystem. Susan is passionate about improving health care and has deep expertise in regulatory compliance and optimizing strategies for success. Susan serves as VP, Outcomes and Clinical Transformation for WebPT and is ED of Keet Outcomes Qualified Clinical Data Registry (QCDR) for participation in MIPS and other quality payment programs.

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