MACRA -Quality Payment Program

When the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law, it permanently repealed the sustainable growth rate formula (SGR) for physician payment. Currently, physicians participate in several overlapping Medicare reporting programs such as the electronic health records incentive program (Meaningful Use), the Physician Quality Reporting System and the value-based modifier. MACRA replaces these programs. Under MACRA there will be two pathways for physician payments. Most physicians will be paid under by way of the modified fee-for-service model called the Merit-Based Incentive Payment System (MIPS). There will also be an advanced alternative payment model pathway, in which physicians participating in payment models specifically approved by the Centers for Medicare and Medicaid Services (CMS) can receive an annual bonus payment.

These payment models are of critical interest to the APRN and physician assistant (PA) communities because they will be used in the future to determine the combination and reimbursement of various care teams. Data collection under MACRA will increase the accountability of various team providers and be able to track the specific contributions of APRNS and PAs to quality and outcomes of care. Medicare Administrative Contractors will be notifying practices through May which clinicians associated with their taxpayer identification number must participate this year in the Merit-based Incentive Payment System (MIPS), one of two new payment pathways for clinicians under MACRA. Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists should participate in MIPS for the 2017 transition year if they annually bill more than $30,000 in Medicare Part B allowed charges and provide care for more than 100 Part B-enrolled Medicare beneficiaries. For more on MACRA and MIPS, visit CMS's Quality Payment website and the American Hospital Association's MACRA webpage. 

Implications of MACRA

  • American Hospital Association issued a brief and toolkit. 
  • Comments submitted by the APRN Working Group outlines the impact on APRN practice. 
  • The American Association of Physician Assistants developed a FAQ.   

Since MACRA equally affects APRNs and physician assistants (PA), look at the following questions:

  1. What are the PA-friendly provisions?
  2. What are the other important provisions?
  3. How does the MIPS provision affect PAs and their patients?
  4. Can a PA practice in a hospital outpatient department bill for chronic care management?
  5. Are PA-led patient-centered medical homes eligible to receive an incentive payment for the management of patients with chronic disease?