Sponsors (4)
The bill shifts Medicare payments to strongly reward high-performing clinicians and provide targeted support to small practices, but it also imposes steep payment cuts and threshold rules that could threaten financially fragile providers and introduce complexity for beneficiaries and payers.
Medicare clinicians who score above the composite performance threshold will receive a 25% higher DPPS payment multiplier beginning in 2028, increasing pay for higher-performing clinicians and practices.
Small or under-resourced practices that qualify in DPPS savings years will get lump-sum incentive payments to invest in care management, EHRs, and social‑needs supports.
Clinicians and practices gain a defined, predictable adjustment-factor structure (fixed multipliers) for 2028 and later, improving transparency and financial planning.
Clinicians who are treated as achieving the lowest composite scores could have Medicare payments cut to 50% of prior rates, risking the financial viability of small or resource‑limited practices.
Clinicians with composite scores below the threshold will receive a 25% pay cut (multiplier 0.75) from 2028 onward, reducing Medicare revenue for many providers.
Tying conversion-factor updates to the adjustment multipliers could reduce the effective updates to physician fees and complicate Medicare beneficiary cost‑sharing calculations (even though coinsurance is held harmless when updates are negative).
Based on analysis of 2 sections of legislative text.
Renames MIPS to DPPS and replaces the MIPS adjustment formula with fixed multipliers tied to composite performance scores beginning in 2028.
Official title: To amend title XVIII of the Social Security Act to transform the Merit-based Incentive Payment System into the Data-driven Performance Payment System under the Medicare physician fee schedule, and for other purposes.
Introduced April 30, 2026 by Mariannette Miller-Meeks · Last progress April 30, 2026
Replaces the current Merit-based Incentive Payment System (MIPS) with a renamed Data-driven Performance Payment System (DPPS) and requires HHS to treat references to MIPS as references to DPPS during a transition. Beginning with 2028, it replaces the existing adjustment-factor formula with a fixed multiplier table that ties Medicare payment adjustments to composite performance scores for clinicians. The law takes effect January 1, 2027, directs the Secretary of Health and Human Services to manage the terminology transition, and changes statutory wording and numbering while establishing specific multipliers (1.25, 1.0, 0.75, 0.5) tied to performance thresholds for DPPS adjustments in 2028 and later years.