Sponsors (3)
The bill shifts Medicare clinician pay toward stronger performance incentives and predictable multipliers—boosting higher performers and providing targeted incentives for some small practices—while imposing steep cuts on lower scorers and tying updates in ways that could reduce effective payment growth and complicate beneficiary cost‑sharing.
Healthcare workers and hospitals that score above the performance threshold will receive a 25% higher DPPS payment multiplier (1.25) beginning in 2028, increasing Medicare payments to higher‑performing clinicians and systems.
Clinicians and practices gain a defined, predictable adjustment-factor structure (fixed multipliers beginning 2028) that improves transparency and makes revenue and budgeting more predictable for providers and health systems.
Small or under‑resourced practices qualifying in DPPS savings years will receive lump‑sum incentive payments to invest in care management, EHR upgrades, and social‑needs supports, helping resource-limited providers improve care capacity.
Small, resource-limited practices, clinicians with lower performance, and many health‑system providers face steep Medicare payment reductions—up to a 25% cut for below-threshold performers and a 50% payment multiplier for those treated as lowest scorers—which could threaten financial viability and access to care in underserved areas.
Linking conversion-factor updates to the adjustment multipliers can reduce the effective physician-fee update and complicate beneficiary cost‑sharing calculations (and federal budget/taxpayer effects), potentially increasing complexity for Medicare beneficiaries and reducing the real-dollar growth of payments.
Capping the performance threshold at 75 points (2028–2033) creates abrupt cutoffs that limit upward mobility and may unfairly penalize providers who are just below the cap, raising equity and fairness concerns in how payments are distributed.
Based on analysis of 2 sections of legislative text.
Replaces MIPS with a 'Data-driven Performance Payment System' and sets fixed multipliers for 2028+ tied to composite performance scores.
Introduced April 30, 2026 by Mariannette Miller-Meeks · Last progress April 30, 2026
Creates a new payment framework called the Data-driven Performance Payment System (DPPS) to replace the current Merit-based Incentive Payment System (MIPS) for Medicare physician payment policies, with the change effective January 1, 2027. The bill requires the Department of Health and Human Services to treat existing statutory references to MIPS as references to DPPS during a transition and sets a new, fixed adjustment multiplier scheme for 2028 and later years based on a clinician’s composite performance score. The legislation updates statutory language and numbering in the Medicare physician payment statute, clarifies transitional references, and replaces the existing variable adjustment-factor formula with four fixed multipliers (1.25, 1.0, 0.75, 0.5) tied to whether a clinician’s composite score is above, at, below, or at the lowest score relative to a performance threshold. The bill starts other technical revisions to how adjustment factors are applied but leaves some details to be completed in implementing regulations and future statutory text.