A new legislative proposal was submitted to the U.S. Senate Finance Committee and the Centers for Medicare & Medicaid Services by the American Medical Association to reform the current Merit-based Incentive Payment System (MIPS) and transition to a redesigned program called the Data-Driven Performance Payment System (DPPS).

Why change is proposed

The current MIPS program has been widely criticized for imposing high administrative and financial burdens on physicians, particularly those in small, rural, specialty, and independent practices. Physicians face penalties of up to 9% for noncompliance, while participation requires significant time and financial investment, limiting engagement in value-based care initiatives.

Key legislative proposals in the DPPS model

  • Replace punitive payment structure
  • Stabilize performance thresholds
  • Fund practice improvement
  • Ensure timely CMS data

What this means for sleep medicine professionals

Reduced financial risk

  • Lower exposure to penalties, especially for small or independent practices
  • More predictable reimbursement based on participation rather than perfect performance

Better clinical alignment

  • Stable thresholds and simpler scoring that reflect the complexity of sleep care

Improved data access

  • Quarterly data to help track adherence (such as positive airway pressure use, and identify care gaps

Stronger quality programs

  • New funding to support electronic health record integration, quality initiatives, and participation in value-based care

Greater equity for smaller practices

  • Targeted support and reduced burden for independent laboratories, rural professionals, and smaller practices

The proposed transition from MIPS to DPPS represents a meaningful shift toward a more sustainable, data-driven, and equitable value-based payment model. For sleep medicine professionals, the changes could reduce administrative burden, improve access to actionable data, and create new opportunities to invest in quality improvement. While the legislation remains under consideration, it signals a continued push to better align reimbursement with outcomes while making participation more practical for specialty care professionals.

In 2024, the AASM endorsed the AMA Federation letter for MACRA Reform, reflecting support for efforts to reform MIPS and transition to a redesigned payment model. A related 2024 article is available here.

Members may send questions about this proposal to quality@aasm.org.