The Centers for Medicare & Medicaid Services has released the first round of details on its new physician payment plan starting in 2019.

The proposed rule, detailed in a 963-page document published in the Federal Register on April 27, is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed the sustainable growth rate that governed Medicare physician payment since 1998. MACRA will offer physicians two programs: the Merit-based Incentive Payment System, which consolidates three other existing physician payment programs, and an alternative payment model option, which would include programs like the Comprehensive ESRD Care Initiative, a five-year demonstration that began last October in the renal community and includes 13 sites.

The MIPS consolidates three existing payment models: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and Medicare’s incentive program for achieving meaningful use of electronic health records. Under MIPS, physicians will select six outcomes-oriented measures to track. The APM path will reflect traditional Medicare payments in its first two years and then will be opened to all payers, including Medicare Advantage plans.

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Feedback on the proposed rule has already been heard from health care groups. According to an April 27 article in Modern Healthcare, the proposed rule would disallow a number of already-existing alternative payment models as part of the new payment system. “They’re essentially dooming physicians to participating in MIPS,” said Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, in the article. “They’ve been doing all this work and none of it qualifies. I think there’s going to be a lot of pushback from a lot of people.”

Miller gave a talk on new payment models for physicians at the Renal Physicians Association’s annual meeting held in March.

The proposed rule would use a program called Advancing Care Information, accounting for 25% of physicians’ performance score, which will allow them to select the measures they report.

Comments on the proposed rule must be sent to CMS by June 27.