MACRA for Busy Docs: 12 Things to Know

Leigh Page


September 07, 2016

In This Article

A New Way to Pay Physicians

1. Payment Is Related to Patient Outcomes

MACRA, which was signed into law in April 2015, represents a whole new way of allotting Medicare Part B payments to physicians and other clinicians: It is based on patient outcomes rather than quantity of services.

The engine that drives this work is the alternative payment model (APM). In such APMs as accountable care organizations (ACOs), clinicians gain or lose payments depending on their patients' clinical outcomes or some proxy measurement.

There are two tracks in MACRA: advanced APMs and the Merit-Based Incentive Payment System (MIPS), which prepares clinicians to join advanced APMs. But CMS estimates that only 4%-11% of clinicians will qualify for advanced APMs, according to a report[1] by the Brookings Institution. So the vast majority of eligible clinicians will be in MIPS.

"These changes mark a new era, in which Medicare offers powerful incentives for physicians to participate in ACOs and other innovative payment and delivery models," according to an article[2] in the New England Journal of Medicine that was cowritten by Jonathan Oberlander, PhD, a health policy expert at the University of North Carolina at Chapel Hill.

Because there is no ironclad evidence that APMs work, the article was titled "Leap of Faith." "It is far too early to conclude that such APMs will save substantial amounts of money or improve care quality and patient outcomes," the authors wrote.

Few clinicians are ready for APMs, much less for advanced APMs that take on "more than nominal financial risk," which is the goal of the 2015 law. Therefore, the major thrust of the law is the journey toward advanced APMs, rather than the destination.

2. MACRA Applies to More Than Just Physicians

In addition to physicians, MACRA will apply to nurse practitioners and physician assistants, including those in your practice. Just like you, these clinicians will have to report metrics and be assessed for quality and resource use. They will also count toward the size of your practice in measurements required by MACRA.

MACRA will also immediately apply to clinical nurse specialists and nurse anesthetists. Together, all of these providers are referred to as "eligible clinicians" (ECs) in CMS-speak. In the third year, the list of ECs will expand to physical or occupational therapists, nurse-midwives, clinical social workers, clinical psychologists, and several other groups.

However, MACRA does not apply to Medicare payments to hospitals or to Medicaid, which will continue with its own version of meaningful use (MU) even as Medicare MU switches over to a new program.


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