Data-driven Performance Payment System

Summary#

This bill renames and changes the current Merit-based Incentive Payment System (MIPS) to the Data-driven Performance Payment System (DPPS) starting January 1, 2027. For 2028 and later years it sets new payment adjustment multipliers tied to a provider's composite performance score: 1.25 for above the performance threshold, 1.0 for equal to the threshold, 0.75 for below the threshold, and 0.5 for providers who are treated as having the lowest possible scores on required measures. The bill limits applying the multipliers when the official update to the conversion factor is negative and protects some providers from penalties if they do not receive timely quarterly feedback.

The bill sets a temporary performance-threshold rule for 2028–2033 that caps the threshold at 75 points and lets the Secretary extend that rule in extraordinary circumstances. The Comptroller General must report recommendations by December 31, 2029 for a replacement method to set the performance threshold after that period.

The bill requires budget-neutrality adjustments for 2028 and later years so increases for some providers are offset by decreases for others. It also creates a mechanism to pay lump-sum incentive payments to eligible professionals in small practices in years when DPPS produces net savings. Small practices are generally defined as 15 or fewer professionals; the Secretary may prioritize small practices in rural areas, health-professional shortage areas, medically underserved areas, or low-scoring small practices. These lump-sum payments must be used for activities such as care management, addressing social needs, adopting certified EHR technology, improving performance, or participating in value-based care models. The Secretary is given authority to manage transitions in terminology and to issue rules where the bill calls for Secretary actions.

What it means for you#

• If you bill Medicare as a physician or eligible professional, your Medicare payment updates could be multiplied by a DPPS adjustment factor based on your composite performance score beginning in 2028.
• Small practices (generally 15 or fewer professionals) that report data and attest may be eligible for one-time incentive payments in years when the program shows net savings. The Secretary may prioritize rural, shortage-area, medically underserved, or low-scoring small practices.
• To avoid some negative adjustments, the bill requires timely quarterly confidential feedback on administrative claims-based measures; providers must receive that feedback within 60 days after each quarter to qualify for protections described in the bill.
• The Secretary will issue additional rules and may use notice-and-comment rulemaking for transitions and threshold changes.

Expenses#

No publicly available information on total dollar costs or estimated federal budget effects is included in the bill text or metadata provided. The bill itself requires that the program remain budget neutral for 2028 and later years and specifies that lump-sum incentive payments to small practices be funded from net DPPS savings when those savings exist, but it does not list dollar amounts.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.