The Merit-Based Incentive Payment System (MIPS) went into effect this January for therapists—ushering in a new era of incentive-based payments for eligible physical therapists (PTs), occupational therapists (OTs) and speech language pathologists (SLPs). It’s a major change for the industry and will force participating therapists to reassess every aspect of their practice to ensure they can earn the highest possible MIPS score—and avoid negative reimbursement.
Now that we’re a few months into the first performance year for eligible therapists, we wanted to find out: what do therapists know about MIPS and do they understand their eligibility status? We took a quick “pulse-check” poll of over 55 PTs, OTs and SLPs, and here’s what we learned:
1 – The majority (56%) said they don’t understand MIPS
When asked “How knowledgeable do you feel about MIPS?” 56% said they didn’t understand MIPS. Only 4% said they were “very knowledgeable” and 40% said they were “somewhat knowledgeable.” Given that MIPS was just finalized in November for therapists and there were significant changes made in the final rule, such as the inclusion of SLPs, it’s not surprising that therapists don’t fully understand MIPS and what it could mean for their practice.
While not all therapists will be eligible to participate, it’s worth noting that nearly half (49%) of respondents work in a private practice, which makes them more likely to be eligible than any other practice type.
As a reminder, MIPS applies to Medicare Part B professional services. Clinicians may participate as an individual or as part of a group, depending on the type of practice. MIPS-eligible clinicians are identified by a unique billing Tax Identification Number (TIN) and their National Provider Identifier (NPI) number. Hospitals, skilled nursing facilities and rehab agencies are not qualified entities because their services are identified by the practice’s NPI, not the individual practitioner NPI.
Eligibility depends on whether the therapist meets at least one of the low-volume threshold criteria for MIPS participation (details on the low-volume thresholds and other criteria can be found in our MIPS Primer).
2 – 72% are not sure of their own eligibility status
A lack of understanding naturally leads to uncertainty about eligibility. Most therapists polled (72%) didn’t know whether they’re eligible. 19% said they were eligible, but not mandated to participate, and only 5% said they were eligible and mandated to participate.
3 – The majority of eligible therapists feel confident they will perform well under MIPS
Of the respondents who indicated they were eligible, 60% said they feel confident they will perform well under MIPS. This should be encouraging news to those who haven’t figured out their status yet or may be concerned. MIPS is not something to be afraid of, but rather embrace.
While 2019 is the first year for eligible therapists, MIPS has been in effect since 2017 for other clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. According to findings from CMS, 93% of MIPS-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95% overall avoided a negative payment adjustment. These results are a positive indicator that therapists will likewise be able to benefit from incentive-based payments. However, time is of the essence. As CMS noted, “These results demonstrate that clinicians who engaged early and meaningfully participated experienced success.”
Where do you stand?
To earn a positive performance score for 2019, now is the time to get up to speed on MIPS! Take the time to check your status and, if eligible, start thinking about how you want to be measured so you can set yourself up for success—and optimal reimbursement.