Preparing Students for Value-Based Reporting through Documentation Reviews within a Pro Bono Clinic
Purpose
In January 2019, the Center for Medicare and Medicaid Services (CMS) implemented a data quality reporting system, called the Merit-Based Incentive Payment System (MIPS), for physical and occupational therapists (PT/OT) in private practice who serve patients with Medicare Part B insurance. Therapists registered through MIPS must report performance-based patient data that is measured and assessed, which ultimately determines if a therapist or practice will earn an upward, downward or no payment adjustment. According to the APTAÕs Website, the 2019 PT/OT specialty measure set for MIPS comprises eleven total measures, including four claims-based measures, known as the Quality Payment Program (QPP) measures. Due to CMS rules, physical therapy students have limited opportunities to treat and document on patients with Medicare Part B insurance. Therefore, students may not be well informed about MIPS and QPP measures, which could inevitably put a therapist and/or private clinic at risk for a downward adjustment for Medicare Part B reimbursement. The purpose of this study was to determine if students in a physical therapy program were documenting QPP measures during a physical therapy evaluation of patients in a pro bono setting.
Methods/Description:
A retrospective evaluation, utilizing a QPP checklist, of student documentation in a pro bono clinic from January 2016 through December 2019 was conducted.
Results/Outcomes:
One hundred fifty-seven charts from January 2016 through December 2019 were reviewed. Although students often documented a medication review (82.6%) or a functional outcome assessment (65.6%), less than 10% of the time students were documenting/reporting on all four claims-based measures or at least six quality measures, including at least one outcome measure.
Conclusions/Relevance to the conference theme:
By implementing a quality assurance review in a pro bono setting, which includes whether or not QPP measures were documented, students can be further educated on appropriate QPP questions/measures so that they are better prepared for the outpatient clinical environment, especially when working with individuals with Medicare Part B. Due to the 2020 changes for the MIPS, it is recognized that education should reflect these changes and students should report on at least six of the quality measures, including BMI screening and follow-up, documentation and verification of current medications in the medical record, screening for depression and follow-up plan, fall risk assessment, fall risk plan of care, elder maltreatment screen and follow-up plan, and functional outcome assessment. Future studies may include examining whether additional education leads to better QPP quality assurance results, and, ultimately, graduates who properly understand and utilize QPP measures in outpatient settings.