The Centers for Medicare & Medicaid Services (CMS) proposed reforms to Medicare’s physician payment and value-based care programs that would expand accountable care, modernize physician payment, reduce administrative burden, and help shift the healthcare system’s focus from treating illness to preventing it.
The proposals would make Medicare accountable care organizations (ACOs) easier to join and more rewarding to participate in, transition clinicians away from traditional Merit-based Incentive Payment System (MIPS) reporting toward value-based care pathways, and update the physician fee schedule policies to better reflect modern clinical practice.
“Expanding accountable care is a critical part of making the Medicare program work well for patients,” said John Brooks, CMS deputy administrator and director of the Center for Medicare. “Our goal is simple: deliver better outcomes for patients by appropriately incentivizing providers, improving quality measurement, and reducing administrative burden.”
The proposed changes to the Medicare Shared Savings Program, the value-based payment program, would support continued participation and growth in accountable care. ACOs are groups of doctors, hospitals, and other healthcare providers who work together to coordinate care for people with original Medicare to focus on prevention, care management, and patient engagement.
The Shared Savings Program has generated savings for the Medicare Trust Funds for eight consecutive performance years, CMS said, and the proposed rule would build on the savings by improving benchmark accuracy, supporting continued and expanded participation, and reducing unnecessary administrative burden.
Updates to the physician fee schedule would better reflect modern medical practice and support the “administration’s goal of shifting from sick care to healthcare” with a targeted recalibration of payment rates to improve accuracy, transparency, and consistency.
The proposal would sunset traditional MIPS reporting in 2029 toward more “clinically meaningful specialty-focused” MIPS Value Pathways (MVPs). When MIPS was launched in 2017, its goal was to move Medicare away from a fragmented fee-for-service system toward one that rewards quality, outcomes, and value. CMS is proposing three new MVPs focused on diabetes, hypertension, and hospital-based care to further expand participation opportunities and promote prevention. The proposal would introduce new MIPS Core Measures beginning in 2027. Under this approach, every clinician would report at least one measure considered fundamental to their specialty and patient population with a goal to improve consistency and generate more meaningful quality data for patients, providers, and policymakers.
To read the proposed rule, visit the Federal Register.
Visit the CMS website to read the following related documents:
The Quality Payment Program Fact Sheet
The CY 2027 Physician Fee Schedule Proposed Rule Fact Sheet
