Reforming MIPS: Key Legislative Developments and Healthcare Models

Physicians in the U.S. have encountered significant challenges with the Merit-based Incentive Payment System (MIPS), prompting legislative action for reform. H.R. 8622, the Medicare Physician Data-driven Performance Payment System (DPPS) Act of 2026, has been introduced by Representatives Mariannette Miller-Meeks, MD, and Herb Conaway, MD. This proposed legislation aims to enhance the efficiency and fairness of MIPS, addressing criticisms regarding penalties and administrative burdens deterring private practices.

The DPPS Act is expected to alleviate pressures on physicians, particularly those in smaller or rural practices. The American Medical Association (AMA) applauds this initiative, seeing it as a pathway to substantial relief for participants in MIPS. According to AMA President Bobby Mukkamala, MD, the high costs and demands of MIPS compliance have contributed to a shift in care settings toward more expensive options.

Policy Updates for Foreign-trained Physicians

In a related development, the Trump administration has updated visa processing policies, lifting the freeze for foreign-trained physicians. The AMA has advocated for exemptions for these professionals, vital in underserved and rural communities, to be excluded from entrance suspensions. Their role in the U.S. healthcare system underscores their critical importance.

New Healthcare Models and Application Deadlines

Applications for the ACCESS model and the MAHA ELEVATE Model are now open, focusing on leveraging technology to improve Medicare patient care and funding health improvement proposals. Additionally, the application deadline for the LEAD Model ACOs, designed to support small, rural, and independent practices, is approaching.

Reforms in Prior Authorization

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule to extend interoperability and transparency requirements for drug prior authorizations. These changes include electronic processes and public reporting of authorization metrics. The AMA has played a key role in shaping these reforms, aiming to reduce administrative burdens and improve patient access to necessary medications through these enhancements.

The AMA continues to champion regulatory changes to bolster accountability for payers, advocating for careful implementation to benefit both physicians and patients. Such efforts emphasize the importance of prompt access to medications and the smooth execution of these reforms within the healthcare landscape.