Limber Health Introduces Expanded Outcomes Collection Platform  > READ MORE
Icon - Elements Webflow Library - BRIX Templates

All Posts

Navigating MIPS: A Physical Therapist's Guide to QCDRs and Value-Based Care

April 24, 2024
Learn how to navigate MIPS (Merit-based Incentive Payment System) as a Physical Therapist with our guide, covering QCDRs, value-based care, and more. Maximize reimbursements and enhance patient outcomes while simplifying complex concepts.
Healthcare Provider examining diagnostic image

For physical therapists committed to delivering top-notch patient care, the Merit-based Incentive Payment System (MIPS) provides an avenue to receive recognition and reward for their efforts and support the transition to value-based healthcare. However, understanding MIPS, Qualified Clinical Data Registries (QCDRs), and Qualified Registries (QRs) can be challenging. Fortunately, this guide is designed to simplify these concepts for practitioners.

The History of MIPS

MIPS emerged as a component of the Medicare Access and CHIP Reauthorization Act of 2015. Its inception aimed to establish a value-driven healthcare framework, incentivizing eligible clinicians to deliver exceptional care, enhance patient outcomes, and receive increased reimbursements. Initially introduced in 2017 for qualifying providers such as Medical Doctors and Doctors of Osteopathic Medicine, this budget-neutral initiative expanded in 2019 to encompass allied healthcare professionals like Physical and Occupational Therapists.

Comprehending MIPS reporting is essential for healthcare providers engaged with Medicare, as it enables them to maximize reimbursements while delivering outstanding care.

Understanding MIPS and the Value Shift

The Merit-based Incentive Payment System or MIPS is a program from the Centers for Medicare & Medicaid Services (CMS) that ties a portion of your Medicare Part B payments to performance in four key categories.

The four performance categories of MIPS are:

  • Quality: Measuring clinical outcomes and adherence to best practices.
  • Cost: Reducing unnecessary healthcare spending.
  • Improvement Activities: Engaging in activities that advance quality care.
  • Promoting Interoperability: Sharing data electronically to improve care coordination.
MIPS ties a portion of Medicare Part B payments to performance in these four categories

Each year, eligible Medicare Part B clinicians and organizations gather and submit data across these four categories, forming the basis for MIPS to compute a score on a 100-point scale known as the Composite Performance Score (CPS). This score directly influences Medicare reimbursements, with higher scores resulting in payment bonuses and lower scores potentially triggering payment adjustments.

It's worth noting that historically, allied healthcare professionals (such as PTs, OTs, SLPs) were evaluated solely on the Quality and Improvement Activities categories, while physicians were assessed across all four performance categories.

However, in light of the 2024 CMS Final rule, allied healthcare professionals in large practices are now accountable for the Promoting Interoperability category and the Cost category as well.

What is the value of participating in MIPS?

  • Financial incentives: Good performance in MIPS can earn you positive payment adjustments, while poor performance could lead to reductions.
  • Future of healthcare: Value-based care is the future, and MIPS participation gives you a head start in adapting to this data-driven approach.
  • Patient-centered care: MIPS emphasizes patient-reported outcomes (PROs), putting your patients' voices at the heart of care decisions.

Choosing your Pathway - QCDRs vs. Qualified Registries

To participate in MIPS, you need to report your performance through a Qualified Clinical Data Registry (QCDR) or a Qualified Registry. Both collect and submit data to CMS, but with some key differences:


  • Focus: Primarily on clinical quality measures relevant to your specialty (e.g., physical therapy functional outcome measures).
  • Membership: Open to all eligible clinicians, regardless of practice setting.
  • Data collection: May offer tools and resources to help you collect PROs directly from your patients.

Qualified Registries:

  • Focus: Broader scope, including quality, cost, and improvement activity measures.
  • Membership: Often limited to specific groups of clinicians (e.g., a hospital network).
  • Data collection: May rely on existing electronic health records (EHRs) to pull data, potentially reducing your workload.
  • Cannot use QCDR specialty measures

Which one is right for your practice?

Consider your practice setting, data collection preferences, and the measures you want to focus on. Research different QCDRs and registries, speak with colleagues, and choose the one that best aligns with your needs and goals. 

Limber’s QCDR, Advancing Musculoskeletal (MSK) Care & Rehabilitation QCDR, offers white-glove support to give you the tools necessary to participate in MIPS, regardless of your practice size successfully.

Preparing for MIPS Reporting

  • Familiarize yourself with the MIPS measures: Understand which measures apply to you and how to collect data for them. Learn about the new MSK Measure Set HERE
  • Check your eligibility and special designations
  • Integrate PROs into your workflow: Train your staff and patients on using PRO tools and questionnaires.
  • Utilize QCDR/registry resources: Many offer educational materials, technical support, and data analysis tools.

MIPS Reporting and Beyond

The MIPS reporting periods run from January to December, with final submissions taking place Jan-March of the following year. But remember, MIPS is an ongoing process. It’s important to continuously analyze your results, identify areas for improvement, and adjust your approach to achieve success.

Additional MIPS Resources

The Bottom Line

Participating in MIPS can be valuable for physical therapists who want to be at the forefront of quality healthcare and value-based payment. By choosing the right QCDR or registry, collecting meaningful PROs, and continuously improving your performance, you can thrive in the evolving healthcare landscape.