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Latest Efforts and Resources

Advocacy

Scope of practice expansion is a long-standing, continuous, and complex concern in the health care field. AAPM&R is aware of the various concerns specifically plaguing physiatrists, from non-physicians to non-physiatrists, intent on expanding their scope of practice beyond their level of education, training, and experience. 

AAPM&R is taking action.

Your Academy remains vigilant about ongoing efforts by non-physician and non-PM&R providers to expand their scope of practice beyond their level of training, which may threaten the health and safety of patients and impact the livelihood of physiatrists.

AAPM&R's Scope of Practice Workgroup

Recognizing the growing concern of non-physician (and non-PM&R) scope of practice expansion, your Academy is addressing this issue through multiple committees, including a new Scope of Practice Workgroup. This workgroup is comprised of representatives from the Quality, Practice, Policy, and Research (QPPR) Committee, the Health Policy and Legislation (HP&L) Committee, and the Reimbursement and Policy Review Committee (RPRC), and AAPM&R’s representative to the AMA Scope of Practice Partnership (SOPP).

Scope of Practice Partnership with the American Medical Association (AMA)

Your Academy, as a member of the AMA Scope of Practice Partnership (SOPP), actively engages in the collaborative effort of the AMA, American Osteopathic Association (AOA), national medical societies, state medical associations and state osteopathic medical associations to oppose scope of practice expansions by non-physician providers that threaten the health and safety of patients. The SOPP achieves this goal through legislative activities, regulatory activities, judicial advocacy, and programs of information, research and education. Active participation in this collaborative ensures physiatry is represented and contributes to SOPP’s goal to protect the health and safety of patients whose well-being may be threatened by health care practitioners who lack the education, training or experience to perform procedures for which they seek licensure or recognition.

Protecting Physiatry’s Leadership Within Rehabilitation Hospitals

In 2019, the Centers for Medicare and Medicaid Services (CMS) released the Proposed CY 2020 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Rule, including a proposal to amend the definition of a rehabilitation physician to clarify that the determination as to whether a physician qualifies as a rehabilitation physician (that is, a licensed physician with specialized training and experience in inpatient rehabilitation) is made by the IRF.” In response to this proposal, AAPM&R convened an ad hoc Rehabilitation Physician Workgroup and submitted a strongly worded letter to CMS urging CMS not to finalize its proposal to weaken the definition of rehabilitation physician and requesting that CMS delay any changes to current regulations until stakeholders can develop a consensus approach for protecting the quality and integrity of IRF care. In additional to several additional advocacy actions, AAPM&R secured support from 40 prestigious organizations representing patients, physicians, and large inpatient rehabilitation hospitals on a stakeholder letter to CMS.

In July 2020, CMS finalized the IRF PPS Rule for 2020. In the final rule, CMS deferred to the IRF to define and assess the definition of “rehabilitation physician.” Despite this outcome, we are immensely proud of the work more than 1,100 of our members put into advocating against this proposal. Our members demonstrated that physiatrists are advocates for their patients, in and out of the treatment setting. We know it will take time and perseverance to be successful, but we are stepping up and planning a long-term, strategic initiative. We are making physiatrists’ voices heard. We are advocating for physiatry’s value in medicine.

Click here to read the full timeline of our past efforts.

Click here to read about AAPM&R’s leadership in scoring an enormous advocacy win for the FY 2021 IRF PPS Proposed Rule.

Resources

From ongoing collaborations with the American Medical Association (AMA) to a full toolkit of position statements, we plan to continue developing tangible resources to assist physiatrists in addressing scope of practice issues.

Your Academy's Latest Efforts to Defend Physiatrists' Scope of Practice


View the full list of AAPM&R advocacy letters.


Reminder: CMS Accepting 2023 MIPS Extreme and Uncontrollable Circumstances Exception

Jun 23, 2023

 

The Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception and MIPS Promoting Interoperability Performance Category Hardship Exception applications are available for the 2023 performance year. Applications can be submitted until 8 p.m. ET on January 2, 2024.

MIPS Extreme and Uncontrollable Circumstances Exception Application

MIPS eligible clinicians, groups, and virtual groups may apply to reweight any or all MIPS performance categories if they’ve been affected by extreme and uncontrollable circumstances. Extreme and uncontrollable circumstances are defined as rare events entirely outside of your control and the control of the facility in which you practice. These circumstances must:

  • Cause you to be unable to collect information necessary to submit for a MIPS performance category;
  • Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the quality performance category for 3 months); and/or
  • Impact your normal process, affecting your performance on cost measures and other administrative claims measures.

For Alternative Payment Model (APM) Entities

APM Entities participating in MIPS APMs can also submit a MIPS EUC Exception application. However, the policy for APM Entities differs from the MIPS EUC policy for individuals, groups, and virtual groups in that:

  • APM Entities are required to request reweighting for all performance categories;
  • At least 75% of an APM Entity’s MIPS eligible clinicians must qualify for reweighting in the Promoting Interoperability performance category; and
  • Data submission for an APM Entity won’t override performance category reweighting.

Learn more in the 2023 MIPS Extreme and Uncontrollable Circumstances Application Guide.

MIPS Promoting Interoperability Performance Category Hardship Exception Applications

MIPS eligible clinicians, groups, and virtual groups may apply to reweight the Promoting Interoperability performance category to 0% if they:

  • Have decertified electronic health record (EHR) technology;
  • Have insufficient Internet connectivity;
  • Face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress, or vendor issues; or
  • Lack control over the availability of certified EHR technology (CEHRT); simply lacking the required CEHRT doesn’t qualify you for reweighting.

NOTE: You don’t need to apply for this application if you qualify for automatic reweighting of the Promoting Interoperability performance category based on your clinician type or special status.

As a reminder, small practices qualify for automatic reweighting. Refer to Appendix A of the 2023 MIPS Promoting Interoperability User Guide for a complete list of clinician types and special statuses that qualify for automatic reweighting in the 2023 performance year. Learn more in the 2023 Promoting Interoperability Hardship Application Guide.

How do I Apply?

You must have a Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) account to complete and submit an exception application on behalf of yourself, or another MIPS eligible clinician, group, virtual group or APM Entity. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.

Once you register for a HARP account, sign in to the QPP website, select ‘Exceptions Applications’ on the left-hand navigation, select ‘Add New Exception,’ and select ‘Extreme and Uncontrollable Circumstances Exception’ or ‘Promoting Interoperability Hardship Exception.'

Note for Subgroups

Subgroups will inherit any reweighting approved for their affiliated group; if the subgroup encounters an extreme and uncontrollable circumstance that doesn’t affect the entire group, the subgroup can contact the QPP Service Center to request reweighting.

How do I Know if I’m Approved?

You'll be notified by email if your request was approved or denied.  You can also check the status of your application by signing in to the QPP website and navigating to ‘Exceptions.’ If approved, this information will also be added to your eligibility profile in the QPP Participation Status Tool on a weekly basis. If your application is approved at the end of the performance year, it may not appear in the QPP Participation Status Tool until the submission window opens on January 2, 2024.