The AMA submitted detailed recommendations to CMS designed to ensure new federal reimbursement programs “reward physicians for the improvements they make to their practice and the quality of care they provide to their patients.” The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) would establish payment incentives for physicians and other clinicians based on quality of care rather than quantity (fee for service). The framework for determining care standards is called the Quality Measure Development Plan, which includes measures in six quality “domains”– clinical care, safety, care coordination, patient and caregiver experience, population health and prevention, and affordable care. Providers would be paid based on their quality and cost metrics. CMS says it plans to base reimbursements in 2019 on provider performance starting on January 1, 2017. Writing that “the proposed start date is too early and will create significant problems for the launch of the MACRA programs,” the AMA recommended a six-month delay. “The AMA strongly urges CMS to create an initial transitional performance period from July 1, 2017 to December 31, 2017 to ensure the successful and appropriate implementation of the MACRA programs,” the association wrote.