This summer, cool off with a cold drink and the 1,592-page 2027 CMS Physician Fee Schedule Proposed Rule! CMS has teased the elimination of Traditional MIPS and full transition to MIPS Value Pathways (MVPs for several years), and we now have a proposed date. Starting in Performance Year 2029, MVPs will be the only option […]
What TEAM and ASM Tell Us About the Future of Value-Based Care
In the last year, CMS has made strides to revamp health care through Medicare and Medicaid, taking some controversial steps. But one of their more positive moves involves changes to their Value-Based Care strategy. So, what does that strategy—through new or restructured payment models—tell us about where the system is headed? TEAM, ASM, ACCESS and […]
The 2026 CMS PFS Final Rule: The 5 Ways CMS Aims to Control Total Cost of Care
The CMS PFS Final Rule is out . . . early? If you’re wondering how, in the midst of the Shutdown, a 2,375-page Rule could be released, the answer is simple: most of the proposals from this summer were finalized as is. There are always exceptions, but the big takeaway is that this Rule solidifies […]
CMS is Demanding Change in Specialty Care: 5 Things to Know about ASM
Heads up! CMS’s Proposed 2026 PFS Rule introduces a new payment model for tackling specialty care and costs in traditional Medicare. Clearly not a snap decision, Ambulatory Specialty Model (ASM) has been cooked until well-seasoned and served up in 210 pages of the proposed Rule. Unlike a typical Notice from the CMS Innovation Center that […]
CMS Commits to Control Total Cost of Care: 6 Volleys in the 2026 CMS PFS Proposed Rule
Summer is here, and the heat is on: barbeques, beaches, and the 2026 CMS Physician Fee Schedule Proposed Rule. Throughout 1,803 pages, CMS is going after the total cost of care in the MIPS and APM tracks of the Quality Payment Program (QPP). These proposed updates and the creation of a surprise new (and mandatory!) […]
The 2025 CMS PFS Final Rule: The Five-Pronged Strategy Towards Comprehensive Accountable Care
The 2025 CMS PFS Rule landed with a bang, and it’s not just the weight of the 3,088 pages. We’re one year closer to 2030, the year that CMS intends to have all Traditional Medicare patients in a relationship with a clinician who is accountable for total cost of care. The push to the finish […]
CMS Presses for Accountable Care, Better Quality Measurement for Physicians and ACOs in New Proposed Rule
July brings us baseball, fireworks, and CMS’s Proposed Rules. In 2,248 pages of proposals, CMS has outlined its plans for MIPS, ACOs, and other Advanced Alternate Payment Models, and how they will transition from fee-for-service into a value-based care arrangement through the Quality Payment Program (QPP). We already know from the 2024 Final Rule that […]
2022 QPP Experience Report: Address 3 Key Findings Now to Avoid Future Penalties
At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) is enough […]
The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront
The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although […]
New for ACOs: Roji TIPS for Implementing APP Reporting
With the advent of APP Reporting, ACOs face a fundamental change in not only how they report quality measures, but also how they use data to drive results. That’s true whether APP Reporting involves reporting quality for all patients or for Medicare-only patients via Medicare CQMs. Data is an asset that ACOs have never had. […]