MACRA: The Reaction and Impact (Part 2 of 2)

Now that the final rule has been released for the Medicare Access and Chip Reauthorization Act of 2015 (MACRA), reaction from those who have to now react to these changes has been strong on both sides.

Many feel like MACRA is an improvement over the Meaningful Use reporting requirements. Others are strongly opposed to the new requirements, both from a workload standpoint and a philosophical one as well.

Another thing worth considering is the impact of MACRA on other healthcare professionals, including nurses and other “non-patient-facing” providers.

Strong opinions

Dr. Caroline Poplin, a health policy analyst, lawyer, and physician doesn’t hold back her words in an opinion piece on MedPageToday (

“MACRA … is a disaster,” she writes. “It will take the joy out of practicing medicine without significantly improving patient outcomes (except in a circular way) or reducing cost, by moving medical decisions from the bedside to the C-suite. It benefits primarily the health policy community — consultants, academics, executives — who designed it.”

She goes on to discuss how MACRA is an attempt to correct a perception — which may or may not be accurate — that “doctors provide ‘volume,’ not ‘value.’” In this attempted correction, experts have determined what services are valuable, not the market or consumers or even the physicians, leaving the physicians to enter into a points system where everything they do is scrutinized.

“Providers can only receive points for activities that are carefully, correctly measured and documented as structured data in the EHR,” she writes. “The things patients, especially sick patients, want and need most — empathy, time, concern for their well-being — count for nothing. So to be blunt, from now on we are paid only for treating the numbers.”

Dr. Louis Kartsonis, an ophthalmologist, agrees.

“MACRA, with all of its distractions and fool’s errants, not only interferes with the way we practice, but threatens our compensation if we don’t get with the program,” he says in an article on FierceHealthcare ( “This is a flagrant violation of the Medicare law.”

But not everyone sees MACRA as an awful thing.

Dr. Todd Scarbrough, an oncologist, thinks that this is just another hurdle to overcome.

“We’ll just have to pay more attention to what we do,” he says in FierceHealthcare ( “But it is a slightly greater bureaucratic level on physicians.”

Other impacts

In addition to the obvious impact on physicians and providers, MACRA has an impact on others who work in healthcare, specifically nurses and providers who don’t see patients, including pathologists, many anesthesiologists, and nuclear medicine physicians.

According to an article in HealthLeadersMedia by Jennifer Thew, a registered nurse, many nursing organizations are still reviewing the final rule and will make statements accordingly in the coming weeks.

However, the American Organization of Nurse Executives, a subsidiary of the American Hospital Association, has already referred to a statement from AHA executive vice president Tom Nickels.

“AHA is disappointed that CMS continues to narrowly define advanced APMs [Alternative Payment Models], which means less than 10% of clinicians will be rewarded for their care transformation efforts, but is encouraged that CMS is exploring a new option that would expand the available advanced APMs that qualify for incentives,” he wrote (

Things for non-patient-facing providers, however, may not be quite as simple as just disappointment. Maria Calamaro, a product director for a billing and coding company says in an article on Medscape that reporting could be significantly different for these providers, especially from previous quality reporting procedures with the Physician Quality Reporting System (PQRS).

“Non–patient-facing clinicians have been reporting to PQRS and will continue to do so in the new program, but reporting the cross-cutting measure, which applies to all patient-facing specialties, could be a problem,” the article reads ( “PQRS informally exempted non–patient-facing physicians from reporting this measure, but it’s unclear whether that will continue under MIPS.”

It is clearer, however, that non-patient-facing physicians will only have to report to two Clinical Practice Improvement Activities (CPIA), as they were primarily designed for physicians with regular patients.

So, if you’re a non-patient-facing physician, stay tuned.

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