The proposed SGR repeal deal leaves room for doctors and other stakeholders to influence how the new value-based system would be designed, Gilberg said, calling the pact a foundation for change. "We don't know how this is going to play out," he said. "So much is going to be left to the secretary [of Health and Human Services] to flesh out. … What this does is create a set of criteria."
When new standards for physician assessment are set, the selection of indicators to be measured will be a key factor in creating a value-based system, Roman said. "The measures that work are the measures that look at quality and outcomes. A measure should be meaningful and the physician should have the ability to control it."
To quantify value and promote transparency, Roman says reformers should focus on costs rather than physician fees, noting the fees that doctors can charge for their professional services are largely mandated. "We're all on the same fee schedule, but there are huge variations of cost."
Effective healthcare value measurements assess physician performance in areas of their fields where outcomes and costs differ from doctor to doctor, Roman said. "A good measure would be one where there is a high degree of variation," he said.