And while Congress passed a bipartisan law in 2015 creating a new payment framework that is supposed to reward doctors for value over volume, Mr. Trump’s Department of Health and Human Services has exempted more doctors from a provision that created merit pay by giving them bonuses or penalties depending on the quality of their work.

In September, the department released an outline of a “new direction” for the Center for Medicare and Medicaid Innovation, set up by the Affordable Care Act to test models aimed at improving medical care and reducing costs. While the Obama administration had pushed large, mandatory experiments to test new models of pay, the Trump administration wants to encourage smaller, voluntary programs — and has asked the doctors to help design them.



“Clearly a great big foot has been put on the brake,” said Donald Crane, the chief executive of CAPG, a group of doctors and hospital administrators that, unlike many in the profession, has pushed to tie physician pay to quality measures rather than the old model of fee for service.

Mr. Crane was referring specifically to the scaling back of the cardiac and joint replacement programs by Tom Price, an orthopedic surgeon and Republican former congressman chosen by Mr. Trump as secretary of health and human services. Mr. Price, who resigned in September over his use of expensive private jets, had accused the Obama administration of trying to “commandeer clinical decision-making” by forcing doctors to participate in experiments that test new ways of paying for care. Mr. Trump is said to be close to appointing a successor — possibly Alex Azar, a former pharmaceutical company executive who worked in the Department of Health and Human Services under President George W. Bush — and doctors’ groups will be watching carefully to see if the agency continues in the same direction.

Already, other administration officials have signaled support for protecting doctors and giving them more say. The agency’s Centers for Medicare and Medicaid Services, led by Seema Verma, has suggested it will accept more recommendations than it did in the past from a committee of doctors formed by the American Medical Association on how much Medicare should pay for services and procedures — essentially letting doctors set their own pay.