The Centers for Medicare & Medicaid Services released a proposed rule this week on how it plans to pay physicians who treat Medicare patients. But this is no ordinary proposal.

It’s the first rule since Congress permanently eliminated the antiquated and hated sustainable growth rate, a yearly adjustment made to Medicare physicians salaries that in many cases would have amounted to up to 21% in pay cuts. Congress interceded each year, but finally found the votes and support needed to eliminate the SGR in Medicare legislation earlier this year.

For nephrologists and other physicians, the new payment model CMS is developing will focus on rewarding for performance, something similar to the ESRD Quality Incentive Program that dialysis providers must participate in each year. As required by the Medicare Access and CHIP Reauthorization Act of 2015, the law that eliminated the SGR, physicians will get a modest payment increase of 0.5% this year.

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That increase and other provisions mean Medicare will pay physicians and other clinicians $670 million more than in 2015.

Beneficiaries are expected to see a $100 million reduction in out-of-pocket costs as a result of the proposed changes to the fee schedule. Starting in 2019, doctors who have at least 25% of their patients in value-based payment models will be eligible for 5% bonus payments through 2024. After that they’ll receive annual payment bumps of 0.75%, three times the level of increase for physicians that remain on the fee-for-service track.

The proposed changes to the 2016 Medicare physician fee schedule also include a provision activating two new advance care-planning codes and assigning them value. These codes would be used to pay for a provider’s time discussing patient choices for advance directives and completing necessary forms. One code would cover the first 30 minutes and the other would cover any additional 30-minute blocks that are needed.

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“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified healthcare professional,” AMA President-elect Dr. Andrew Gurman said in a statement praising the proposed policy. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

Other provider and advocacy organizations also quickly praised the proposal.

“Patients deserve assistance with advance care planning and it’s essential that these conversations take place before a crisis happens,” Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, said in a news release.

The draft rule would make a variety of changes to the Physician Quality Reporting System, the incentive program for the meaningful use of electronic health records and the value-based payment modifier, all of which are slated to become components of the new Merit-based Incentive Payment System. It also proposes several new components the CMS plans to add to Medicare’s Physician Compare website, including a green check mark next to the name of providers who received an upward adjustment for cost and quality.

CMS is accepting public comments on the proposed rule until Sept. 8.