The Medicare Quality Payment Program's Merit-based Incentive Payment System, or MIPS, continues to evolve since its introduction via the 2015 Medicare Access and CHIP Reauthorization Act, aka MACRA. Now three APTA members will be at the table to help guide that evolution.
Patty Scheets, PT, DPT, MHS, board-certified neurologic clinical specialist; Miriam Rafferty, PT, DPT, PhD, board-certified neurologic clinical specialist; and Stephanie Woelfel, PT, DPT, board-certified wound management clinical specialist, have been appointed to two separate MACRA Wave 6 clinician expert workgroups that will provide input on the development of two episode-based cost measures for potential use in the Medicare Quality Payment Program, or QPP, which includes MIPS.
Scheets and Rafferty will join the movement disorders group, which will focus on cost measures related to conditions such as Parkinson disease, multiple sclerosis, and amyotrophic lateral sclerosis. Woelfel will serve on the cost measure workgroup, focusing on non-pressure ulcer wounds.
Cost measures — basically, how the cost of delivering a particular health care service is determined — are important components of the QPP and a critical factor in value-based care. Getting PTs at the table when these measures are established strengthens the potential for PTs to participate in value-based payment models, now and in the future, in both the public and private payer environments.
Scheets is vice president of quality, outcomes, and compliance at Infinity Rehab in Bellville, Illinois. Rafferty is the director of implementation science and a research scientist at Chicago’s Shirley Ryan AbilityLab and an assistant professor at Northwestern University's Feinberg School of Medicine in the Department of Physical Medicine & Rehabilitation and Department of Psychiatry & Behavioral Science. Woelfel is an associate professor of clinical physical therapy with a dual faculty appointment in the Department of Surgery at the University of Southern California, and director of clinical physical therapy for hospital outpatient services at Keck Medical Center of USC.
The appointments are a win for APTA, which nominated all three members, and another indication that the physical therapy profession's voice is increasingly valued in discussions of quality and value-based payment programs, according to Alice Bell, APTA senior payment specialist.
"The QPP will play an increasingly important role in Medicare payment for physical therapist services, so the appointment of PTs to these development groups is good news at the right time," Bell said. "Adding PTs to these groups is an acknowledgment by CMS that our profession provides a unique perspective that needs to be considered when making major decisions around cost measures."
In more appointment news, APTA Board of Directors member Carmen Cooper-Orguz, PT, DPT, MBA, was accepted for another term on the U.S. Department of Health and Human Services’ Advisory Panel on Hospital Outpatient Payment. The panel provides input on ambulatory patient classification groups under Medicare, as well as on appropriate supervision levels for hospital outpatient services.
The appointments reflect a trend of APTA members taking on key roles in groups that develop the codes and measures that influence payment: Late last year, APTA members Jonathan Morren, PT, and Angela Pennisi, PT, DPT, MS, were named alternate advisors to two important American Medical Association Health Care Professionals Advisory Committees, or HCPACs — the Relative Value Scale Update Committee, known as RUC, and the Current Procedural Terminology Committee. Kathleen Picard, PT, DPT, is the CPT advisor, and Rick Rausch, PT, DPT, MS, is the RUC advisor and the committee's co-chair — the first-ever PT co-chair of this powerful group. APTA members recently serving on previous cost measure workgroups include Helene Fearon, PT, FAPTA, and John Heick, PT, DPT, PhD, on the low back pain workgroup; and Bob Richardson, PT, MEd, FAPTA, on the rheumatoid arthritis workgroup.