What’s New in the 2027 QPP Final Rule: Key Updates for MIPS and ACO ParticipantsOn July 14, 2026, CMS issued its proposed 2027 Medicare Physician Fee Schedule (PFS) rule, and it may be the most consequential MIPS update in years. For the first time, CMS has attached a firm end date to traditional MIPS reporting, setting the stage for a full transition to MIPS Value Pathways (MVPs). The proposal also reshapes quality reporting, trims the Promoting Interoperability category, and adjusts how Advanced APM participation is measured.Comments are open through September 14, 2026, with a final rule expected before year's end. Here's what clinicians and practices need to know now.MIPS Value Pathways: A 2029 Deadline Takes ShapeTraditional MIPS Gets a Sunset DateCMS has hinted for years that traditional MIPS wouldn't last forever. This proposed rule finally puts a number on it: 2028 would be the last performance period for traditional reporting. Starting in 2029, any clinician not enrolled in a MIPS Alternative Payment Model (APM) would have to report through an MVP — no more traditional option. Clinicians already in a MIPS APM could still choose the APM Performance Pathway (APP) or APP Plus.Why is it important? Practices now have exactly two performance years — 2027 and 2028 — to pick the right MVP, build the data-collection workflows it requires, and set up subgroup reporting where needed. Waiting until 2029 to start could mean scrambling under a hard deadline.Three New MVPs on the Table for 2027The proposal would grow the MVP roster from 27 to 30, adding:<ul><li>Diabetic Disease</li><li>Hypertension</li><li>Hospitalist</li></ul>Why is it important? Primary care, internal medicine, and hospital medicine clinicians get new options worth evaluating — especially if none of the existing MVPs ever felt like a good match.All 27 Current MVPs Would Get a RefreshCMS isn't just adding new pathways — it's proposing updates across every existing MVP, including:<ul><li>Folding in MIPS core measure options to satisfy the new core measure requirement (more below)</li><li>Adding measures that broaden clinical scope or bring in additional specialties</li><li>Dropping measures slated for removal from the broader MIPS inventory, or swapping in stronger alternatives</li></ul>Virtual Groups Could Finally Report MVPs — Starting in 2029Virtual groups are currently locked out of MVP reporting. CMS proposes to change that beginning with the 2029 performance period, matching the broader shift away from traditional MIPS.Why is it important? Virtual groups still on traditional MIPS should start scoping MVP options now — 2028 would be their last year of traditional reporting before MVPs become mandatory in 2029.Quality Category: A Structural OverhaulIntroducing the MIPS Core MeasurePerhaps the biggest structural shift in the rule is a brand-new designation: the MIPS core measure, which CMS proposes to apply to 78 measures across the quality inventory.This designation would replace the current rule requiring at least one outcome measure (or a high-priority measure when no outcome measure applies). Under the new approach:<ul><li>Traditional MIPS reporters would need one core measure among their six required quality measures.</li><li>MVP reporters would need one core measure among their four required quality measures.</li><li>Small practices would be exempt entirely.</li></ul>Traditional reporters could pull a core measure from the general inventory or an applicable specialty set; MVP reporters would choose one from within their selected pathway. If no applicable core measure exists, clinicians would need to attest to that and report a substitute measure instead. Skipping this step — without qualifying for the small-practice exemption or completing the attestation — would mean losing all 10 points on one required quality measure.Why is it important? Check your current measure set against the proposed core list now. If none of your six measures qualify, plan to either add one or file the attestation and substitute — otherwise you're looking at a zero on a required measure.High-Priority Measure Designation Would DisappearTo make room for core measures, CMS proposes eliminating the high-priority designation altogether, along with the requirement to report an outcome measure (or high-priority substitute) when no outcome measure applies. Both functions would simply go away.Shifts in the Quality Measure InventoryThe proposed inventory for 2027 totals 180 measures, down from 190 in 2026 (QCDR measures aren't counted here, since CMS approves those separately). Key changes include:<ul><li>2 new prevention/chronic-disease measures added, one delayed until 2028</li><li>4 existing QCDR measures folded into the MIPS CQM set</li><li>7 older functional-improvement measures replaced by 5 new PROMIS®-based functional outcome measures for orthopedic patients (neck, back, upper extremity, lower extremity, knee)</li><li>20 measures removed</li><li>43 measures substantively revised</li></ul>New Quality Measures Proposed for the 2027 Performance Period:·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Low Density Lipoprotein Cholesterol (LDL-C) Monitoring and Management·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Improvement for Patients with Neck Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Improvement for Patients with Upper Extremity Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Improvement for Patients with Back Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Improvement for Patients with Lower Extremity Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Improvement for Patients with Knee Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Age-Related Hearing Loss: Comprehensive Audiometric Evaluation·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Patient-Reported Experience with Anesthesia·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Intraoperative Hypotension (IOH) Among Non-Emergent Noncardiac Surgical Cases·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; SGLT2 Inhibitors for Patients with Chronic Kidney Disease (CKD) With or Without Type 2 Diabetes MellitusQuality Measures Proposed for Removal in the 2027 Performance Period:·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 006&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Coronary Artery Disease (CAD): Antiplatelet Therapy·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 007&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Coronary Artery Disease (CAD): Beta-Blocker Therapy—Prior MI or LVEF ≤ 40%·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 143&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Oncology: Medical and Radiation—Pain Intensity Quantified·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 217&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Knee Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 218&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Hip Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 219&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 220&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Low Back Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 221&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Shoulder Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 222&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Elbow, Wrist or Hand Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 320&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Appropriate Follow-Up Interval for Normal Colonoscopy in Average-Risk Patients·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 326&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 332&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Adult Sinusitis: Appropriate Choice of Antibiotic-Amoxicillin With or Without Clavulanate·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 350&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative Therapy·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 378&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Children Who Have Dental Decay or Cavities·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 384&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to OR Within 90 Days·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 415&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Emergency Department Utilization of CT for Minor Blunt Head Trauma (18+)·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 430&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Prevention of Post-Operative Nausea and Vomiting (PONV)—Combination Therapy·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 463&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Prevention of Post-Operative Vomiting (POV)—Combination Therapy (Pediatrics)·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 478&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Functional Status Change for Patients with Neck Impairments·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 483&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Person-Centered Primary Care Measure Patient-Reported Outcome Performance MeasureWhy is it important? If a measure you currently report is on the removal list, you'll need a replacement if this is finalized.Relief for Topped-Out MeasuresCMS proposes applying topped-out benchmarks to 17 quality measures for 2027 (two of which don't currently get this treatment). More notably, topped-out core measures currently capped at 7 points would no longer be capped — they'd be scored against the topped-out benchmark up to a full 10 points.Why is it important? Clinicians consistently scoring near 100% on a capped, core-designated measure could see a real bump in their quality.Performance Threshold Holds at 75No change here — the 75-point threshold finalized through 2028 stays in place for 2027.Why is it important? You'll still need 75 points to avoid a negative payment adjustment, even as the measures used to get there shift underneath you.Promoting Interoperability: Trimmed Down, With New Prior Auth RulesCEHRT Definition UpdateCMS proposes a technical update to the Certified EHR Technology (CEHRT) definition to match certification criteria being removed under the separate HTI-5 rule. This shouldn't immediately change reporting obligations.Two ONC Attestations Would Go AwayStarting with the 2026 performance period, CMS proposes dropping:<ul><li>The required ONC Direct Review attestation</li><li>The optional ONC-ACB Surveillance attestation</li></ul>Why is it important? Fewer boxes to check next submission cycle — but hold off removing them from your workflow until the rule is finalized.Security Risk Analysis Measure on the Chopping BlockCMS proposes removing the long-standing Security Risk Analysis measure from the PI category starting in 2027.Why is it important? This drops one required PI measure — but it only affects the MIPS PI measure. Your separate HIPAA security risk analysis obligations don't go anywhere.Electronic Prior Authorization: Optional Now, Mandatory LaterThis measure has a winding path ahead. Previously finalized as required starting in 2027, CMS now proposes to:<ul><li>Make it an optional bonus measure for 2027 instead of required</li><li>Make it required starting in 2028</li><li>Require anyone reporting it in 2027 to use specified FHIR-enabled, ONC-certified modules within CEHRT</li><li>Require, from 2028 on, that CEHRT include modules certified to all three ONC electronic prior authorization criteria</li></ul>A companion measure — Electronic Prior Authorization for Prescription Drugs — would become required in 2028, requiring FHIR-enabled modules to complete at least one drug-related prior auth request.Why is it important? You get one extra year before electronic prior auth is mandatory. Use 2027 to confirm your EHR supports the required FHIR modules, especially if you're chasing the bonus for the optional measure.Improvement Activities: Six In, Eleven OutCMS proposes:<ul><li>6 new activities added</li><li>5 existing activities modified</li><li>11 activities removed</li></ul>New Activities Proposed for 2027<ul><li>Use of Data to Improve Practice Workflows</li><li>Understand and Improve Diagnostic Performance</li><li>Systematic Screening and Intervention for Nutrition and Other Health-Impacting, Non-Clinical Issues</li><li>Advance Care Planning Conversations to Support Patient Wellness and Care Preferences</li><li>Clinician Use of Artificial Intelligence (AI) to Improve Patient Care</li><li>Lifestyle Approaches to Diabetes Remediation</li></ul>These touch on care coordination, diagnostic safety, nutrition, advance care planning, responsible AI use, and diabetes management.Activities Proposed for Removal<ul><li>IA_BE_15 — Engagement of Patients, Family, and Caregivers in Developing a Plan of Care</li><li>IA_BMH_5 — MDD Prevention and Treatment Interventions</li><li>IA_CC_10 — Care Transition Documentation Practice Improvements</li><li>IA_CC_11 — Care Transition Standard Operational Improvements</li><li>IA_CC_12 — Care Coordination Agreements That Promote Improvements in Patient Tracking Across Settings</li><li>IA_CC_16 — Primary Care Physician and Behavioral Health Bilateral Electronic Exchange of Information for Shared Patients</li><li>IA_EPA_4 — Additional Improvements in Access as a Result of QIN/QIO Technical Assistance</li><li>IA_PM_2 — Anticoagulant Management Improvements</li><li>IA_PM_19 — Glycemic Screening Services</li><li>IA_PM_20 — Glycemic Referring Services</li><li>IA_PSPA_2 — Participation in MOC Part IV</li></ul>Why is it important? The new additions reflect emerging priorities like AI use and diagnostic safety. If you're currently reporting one of the 11 activities on the chopping block, you'll need a replacement for 2027.Cost Category: Steady as It GoesNo new cost measures, no removals — just a routine annual update to the list of care episode and patient condition groups and codes, as required by statute.Why is it important? No new prep work needed here but remember cost still carries 30% of the score for traditional MIPS reporters.Advanced APMs: QP Status Could Get More GranularQP Determinations May Move to the TIN/NPI LevelRight now, once a clinician earns Qualifying APM Participant (QP) status, that status — and the MIPS exemption that comes with it — follows them across every TIN they bill under, even practices with no Advanced APM involvement. CMS proposes changing this so QP and Partial QP status apply only at the specific TIN/NPI combination where it was earned.Why is it important? Clinicians billing under multiple TINs, only some of which participate in an Advanced APM, need to reassess their MIPS exposure — QP status would no longer blanket every TIN automatically.Temporary Threshold Relief for 2026Thanks to the Consolidated Appropriations Act, 2026, CMS proposes temporarily lowering QP and Partial QP thresholds for the 2026 performance year:<ul><li>QP: payment-amount threshold drops from 75% to 50%; patient-count threshold drops from 50% to 35%</li><li>Partial QP: payment-amount threshold drops from 50% to 40%; patient-count threshold drops from 35% to 25%</li></ul>These lower thresholds would revert to their higher levels starting in 2027.Why is it important? Easier QP qualification for 2026 — but plan for stricter thresholds to return the following year.MSSP ACO Quality Reporting UpdatesThe rule also touches several MSSP ACO-specific items: continued MIPS CQM reporting availability, an extended MIPS CQM reporting incentive, flat benchmarks for Medicare CQMs, a new Medicare eCQM collection type based on assigned beneficiaries, and revised CEHRT requirements.The Bottom LineThis proposed rule marks one of the biggest shifts to MIPS since the program began. CMS has finally attached a real date to the end of traditional reporting — 2028 would be the last performance period, if finalized — meaning practices that haven't started evaluating MVPs need to get moving.Beyond the MVP transition, the introduction of core measures, the phased rollout of electronic prior authorization, and a leaner Promoting Interoperability category all point toward a program favoring standardized reporting, prevention, interoperability, and clinically meaningful measures.None of this is final yet. CMS is accepting comments through September 14, 2026, and clinicians, groups, and organizations are encouraged to review the proposals closely and submit feedback through <a target="_blank" rel="noopener noreferrer" href="http://Regulations.gov">Regulations.gov</a> before the window closes.&nbsp;

What’s New in the 2027 QPP Final Rule: Key Updates for MIPS and ACO Participants

MIPS Value Pathways (MVP) For Cardiology

What’s New in the 2026 QPP Final Rule: Learn What Changes are Ahead for MIPS Reporting

The Centers for Medicare &amp; Medicaid Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 payment year.<ul><li>Your 2024 MIPS final score determines the MIPS payment adjustment you’ll receive in 2026.</li><li>A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026.</li></ul>The positive payment adjustment for an overall MIPS score of 100 will be 1.05%. In the Final Rule for the 2024 Performance Year, CMS estimated that an overall MIPS score of 100 would earn practices a 2.9% positive payment adjustment. This reduced percentage is due to a number of factors, including the number of practices that received an Extreme and Uncontrollable Circumstances (EUC) exemption. CMS will provide insight into these factors when they publish their 2024 QPP Quality Payment Program Experience Report.&nbsp;Sign into your <a target="_blank" rel="noopener" href="https://qpp.cms.gov/?utm_source=hs_email&amp;utm_medium=email&amp;_hsenc=p2ANqtz--77FFBOuvQJwuijaCkDpnEl75mVUA3Lt0OKEs0ECe_5csykYAhjuV34iIao99_bZwZdaBF">HARP account</a> to view your updated 2024 final scores report to see&nbsp;your actual MIPS payment adjustment.

CMS Releases 2024 Performance Year/2026 Payment Year  MIPS Payment Adjustment Percentages

MIPS Value Pathways (MVP) For Pathology

MIPS Value Pathways (MVP) For Radiology

Under provisions in the Consolidated Appropriations Act, 2026 (H.R. 7148), Congress restored a 3.1% Advanced APM (QP) incentive payment for eligible clinicians who qualify based on their 2026 performance year, which follows the statutory two-year lag, meaning it will be paid out in payment year 2028.&nbsp;Key Details<ul><li>Bonus Amount: 3.1% lump-sum incentive payment.</li><li>Performance Year: 2026.</li><li>Payout Year: 2028.</li><li>Legislation: Consolidated Appropriations Act, 2026 (Public Law 119-75), signed in February 2026.</li></ul>&nbsp;Context and Impact<ul><li>Previous Rates: The incentive was 5% under the original law, dropped to 3.5% (2023 performance year/2025 payment year), and dipped to 1.88% (2024 performance year/2026 payment year) then reduced to zero (2025 performance year/2027 payment year) before being restored to 3.1% (2026 performance year/2028 payment year).</li><li>Thresholds: The act also lowers and freezes participation thresholds for the 2026 performance year to help more providers keep value-based incentives.</li><li>MIPS Relief: Qualifying APM Participants (QPs) get administrative relief by being exempt from traditional Merit-based Incentive Payment System (MIPS) reporting and adjustments on an individual basis.</li></ul>

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What’s New in the 2027 QPP Final Rule: Key Updates for MIPS and ACO Participants

MIPS Value Pathways (MVP) For Cardiology

What’s New in the 2026 QPP Final Rule: Learn What Changes are Ahead for MIPS Reporting

CMS Releases 2024 Performance Year/2026 Payment Year MIPS Payment Adjustment Percentages

MIPS Value Pathways (MVP) For Pathology

MIPS Value Pathways (MVP) For Radiology