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Orgo-Life the new way to the future Advertising by AdpathwayAs part of the 2027 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services proposed several changes to the Medicare Shared Savings Program (MSSP) that seemed to please accountable care organization stakeholders.
CMS said the proposals would make Medicare ACOs easier to join and more rewarding to participate in, transition clinicians away from traditional Merit-based Incentive Payment System (MIPS) reporting toward more meaningful value-based care pathways, and update physician payment policies to better reflect modern clinical practice.
ACO advocacy group Accountable for Health said the proposed rule takes meaningful steps in the right direction by exploring prospective primary care payment, supporting shared medical appointments, better integrating behavior health, and giving ACOs new tools to reduce cost barriers for beneficiaries.
The organization said it also appreciate CMS’s attention to how coding and payment policy can better support care delivery, including its request for feedback on the Current Procedural Terminology (CPT) coding system.
Accountable for Health called these important steps but said that in the future amore prevention-oriented Medicare program will require payment policies that give primary care teams and ACOs the flexibility, resources, and financial stability they need to deliver whole-person care at scale.
In the new rule CMS is proposing to sunset traditional MIPS reporting in 2029 and transition clinicians toward specialty-focused MIPS Value Pathways (MVPs).
As CMS explains, 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. Over the past decade, CMS said it has worked with clinicians to refine the program and reduce reporting burden. The proposed rule establishes MVPs as the primary reporting option in MIPS.
Beginning with the 2029 performance period, traditional MIPS would sunset, marking the next phase in Medicare’s transition toward value-based care. MIPS-eligible clinicians would have until the end of 2028 to transition to an MVP unless they participate in a MIPS APM and report the APM Performance Pathway (APP).
CMS is proposing three new MVPs focused on diabetes, hypertension, and hospital-based care to further expand participation opportunities and promote prevention. If finalized, the MVPs inventory would provide a relevant reporting option for approximately 98% of specialties.
America’s Physician Groups (APG) said it appreciates some other financial specifics, including the increase in the proposed shared savings rate for Level E of the MSSP BASIC track from 50 percent to 60 percent, which continues to increase the potential rewards for organizations participating in the model.
The proposal would allow ACOs to add 75 percent, rather than 50 percent, of their previously achieved savings back into their financial benchmarks when renewing contracts, which APG said would provide financial relief from the “ratchet effect” that tends to lower the benchmarks and make it harder for ACOs to succeed as they become more efficient.
Stakeholders also applauded a proposal to allow ACOs to reduce or eliminate beneficiaries’ Part B cost sharing as a means of attracting beneficiaries to an ACO and enhancing their engagement with it.
CMS is proposing to extend the ability of ACOs to report on quality outcomes via the MIPS Clinical Quality Measures (MIPS CQMs). Also extended would be the MIPS CQM reporting incentive, which enables ACOs to earn maximum shared savings. These provide an alternative quality reporting pathway for ACOs compared to electronic clinical quality measures (eCQMs), for which some ACO participants and their EHR systems are as yet unprepared.
CMS also is seeking feedback on transitioning quality measures and reporting processes to FHIR-based digital approaches for Shared Savings Program ACOs.
APG, however, described the overall physician fee rule as a “double-edged sword. On the one hand, there are positive changes to the MSSP. "On the other hand, the nearly 1.2 percent proposed fee Medicare physician fee cut in 2027 for participants in alternative payment models – and a deeper 1.7 percent cut for other clinicians – constitute a harmful change at a time when physician practice costs are estimated to rise by at least 2 to 2.7 percent.”
“The proposed rule once again cries out for Congressional action to halt these devastating fee cuts at a time when so many physician practices are operating close to the brink,” said Susan Dentzer, APG’s president and CEO in a statement.
In a statement, John Knapp, vice president of Premier Inc., said the proposals align with many of Premier’s longstanding recommendations to strengthen the program. “By enhancing shared savings opportunities, refining benchmarking policies, modernizing quality measurement, and advancing more flexible participation requirements, CMS is taking important steps to make the program more sustainable and attractive for providers. Premier is particularly encouraged by policies that support rural participation and recognize the need for more practical, streamlined approaches to compliance.”
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