On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades."

The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies.

[Also: MACRA proposed rule published by HHS, streamlining federal programs including meaningful use]

"By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients."

So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians.

In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule.

"We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements."

American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians."

In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens."

American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'"

The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs.

CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc.

"Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs.

"We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs.

"As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government."

Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in.

And "Meaningful Use" is going "away" by changing its name to "Advancing Care Information" #MACRA #livetweeting as I read the proposed rule

— Joy Rios (@askjoyrios) April 28, 2016

or basically what #MU should have been from day 1 @Travis_Broome

— Harold Smith III (@haroldsmith3rd) April 28, 2016

1/Bottom Line #MACRA NPRM
Game changer. Lots of great changes, 100's of thoughtful details and decisions.
Biggest blind spot can be fixed

— Farzad Mostashari (@Farzad_MD) April 27, 2016

Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX

— Andy Slavitt (@ASlavitt) April 27, 2016

A tree died for this #MACRA #MIPS #Medicare pic.twitter.com/YsiSd3R9Mf

— Amanda Narod (@AmandaBinDC) April 28, 2016