HCR Update from Mark Sanna: Some members of the Medicare Payment Advisory Commission suggested Medicare take stronger steps to recognize and reward the work of advanced practice registered nurses (APRNs) and physician assistants (PAs). If a particular state allows an APRN to operate independently of a physician, Medicare will pay the APRN 85% of what a doctor would receive for providing that service. But if the APRN must work under a physician, that doctor receives 100% of the payment for that service -- at the regular physician fee schedule rate -- even if the doctor didn't provide it.