Medicare Physician Data-driven Performance Payment System Act of 2026

Protection Against Payment Reductions for Lack of Feedback: DPPS eligible professionals will not be subject to certain negative adjustment factors if they do not receive timely feedback regarding their performance during a quarter. (Section 2(b)(1)(A)(iii)(III))

Stability in Patient Costs: The bill includes a "hold harmless" provision ensuring that patient coinsurance and deductible expenses are computed as if the update to the conversion factor were not subject to the new adjustment factors. (Section 2(b)(1)(A)(iii)(IV))

Support for Small and Under-resourced Practices: Small practices (defined as 15 or fewer professionals) can receive lump-sum incentive payments to help them improve care management, address health-social needs, and implement electronic health record technology. (Section 2(e)(i))

Priority for Rural and Underserved Areas: The Secretary has the authority to prioritize incentive payments for small practices located in rural areas, health professional shortage areas, or medically underserved areas. (Section 2(e)(iii))

Potential Payment Reductions for Lower Performance: Professionals with a composite performance score below a specific threshold may receive a DPPS adjustment factor of 0.75, or as low as 0.5 for those treated as achieving the lowest potential score. (Section 2(b)(1)(A)(ii))

Requirement for New Performance Threshold Methodologies: The Secretary must eventually move away from the current mean or median threshold system to a new methodology based on recommendations from the Comptroller General. (Section 2(c)(3)(vi))