Physician Payment

Questions for the Candidate:  Do you support legislation that defines Ob/Gyns as primary care providers? Do you support allowing Ob/Gyns with a low volume of Medicare patients to be exempt from the many reporting requirements in the new MACRA law? 

In 2015, Congress repealed the flawed Sustainable Growth Rate (SGR) formula, replacing it with the Medicare Access and Chip Reauthorization Act (MACRA) which will begin implementation in 2017. To find out more about MACRA and what it might mean for your practice, click here.

Did you know: states consider ob-gyns as either primary care physicians or specialists. These designations can lead to different reimbursement rates for Medicaid services. Click here to find out your state’s designation and learn about Medicaid reimbursement parity and the primary care pay bump.

Physician Payment

What is MACRA?

In 2015, the US Congress repealed the flawed sustainable growth rate (SGR) formula and replaced it with the Medicare Access and Chip Reauthorization Act (MACRA) which will begin implementation in 2017.  MACRA is now known as the Quality Payment Program (QPP), and is composed of two different components, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). 

MIPS combines existing Medicare reporting programs, namely the Physician Quality Reporting System (PQRS), the Value-based Modifier Payment (VM) program, and the Medicare Electronic Health Record (EHR) Incentive (“meaningful use”) program, into one single program. MIPS will apply sliding-scale bonuses or negative adjustments to the Physician Fee Schedule based on reporting and performance. There are four performance categories that physicians will be measured on: quality, resource use, clinical practice improvement activities, and advancing care information (EHR meaningful use). 

Physicians that participate in Advanced APMs will be exempt from MIPS. MACRA lays out several APMs that physicians can participate in, which include federal medical home models, accountable care organizations (ACOs), and demonstrations under the Medicare Health Care Quality Demonstration Program. MACRA also provides mechanisms for the Centers for Medicare and Medicaid Services (CMS) to develop additional qualifying APMs. Physicians practicing within a qualifying APM will receive a 5% bonus between 2019 and 2024 and a 0.75% increase in the Physician Fee Schedule in 2026 and beyond.

To read more about how MACRA will affect Ob/Gyns and what ACOG is doing, click here.

To learn more about what the Centers for Medicaid/Medicare Services (CMS) has prepared on MACRA, click here.

To watch a short orientation video on the basics of MACRA prepared by the US Department of Health and Human Services, click here.

To watch learning modules on MACRA from CMS, click here.

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998