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CMS-1403-FC
payments should be reasonably related to the measure that
is achieved and, if so, how a reasonable relationship
should be determined, and, if not, how we could protect
against excessive payments that might induce referrals. In
this regard, we are interested in comments addressing [22]
methods for protecting against excessive payments to
referring physicians who participate in the program but may
contribute little or no work or expertise to the program.
We are further interested in comments on [23] the types of
physicians who should be protected participants and what it
should mean to be a “participating” physician. Finally, we
are interested in comments addressing [24] the concept of
restricting physicians from receiving payments for
previously achieved cost savings or for meeting quality
improvement goals that are, or have become over time,
standard practice (for example, we are concerned about
payments that amount to little more than supplemental
payments to physicians to do nothing more than what they
are already doing) (73 FR 38555 through 38556).
In the CY 2009 PFS proposed rule, as described above,
we proposed that payments to physicians be made (whether
directly to the physician or to his or her qualifying
physician organization) on a per capita basis. We also
solicited comments that would “outline alternate approaches
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