For instance, according to current standards, after a patient has a heart attack, doctors should perform a coronary angioplasty to open up a blocked blood vessel within the first hour or so of admission, Nexon said. But if someone develops a drug or device that's better, the doctor won't use it for fear of getting their quality scored lowered, and thus their reimbursement checks docked.

"The key there is if somebody has a new treatment, new drug, that's an alternative to a new process measure, there should be a grace period where a provider is neither penalized nor rewarded," Nexon said.


Also important is ensuring doctors aren't encouraged to cut costs too much, the group said. For that, the lobby hopes CMS adopts a per capita distribution gain-sharing model, where each physician in a group gets the same reward (or same proportional reward), which is capped at 20 or 30 percent of the total they would earn in a fee-for-service system. Nexon said the office of the inspector general proposed a similar cap during an ACO workshop in October.

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