The bill, effective January 1, 2027, renames the Medicare Merit-based Incentive Payment System (MIPS) to the Data-driven Performance Payment System (DPPS) , aiming to enhance physician payment incentives. It significantly reforms the application of adjustment factors for 2028 and subsequent years, establishing clear multipliers based on a professional's composite performance score relative to a set threshold. Professionals scoring above the threshold receive a 1.25 adjustment, while those below receive 0.75 or 0.5, with a 1.0 adjustment for meeting the threshold. Crucially, negative payment adjustments will not apply if the annual conversion factor update is already negative or if eligible professionals do not receive timely feedback on their performance data. The bill also ensures that coinsurance and deductibles are calculated without regard to these performance adjustments, protecting beneficiaries. Furthermore, it introduces a temporary performance threshold of no more than 75 points for years 2028 through 2033, with potential extensions for extraordinary circumstances. Following this temporary period, a new replacement performance threshold methodology will be established through rulemaking, guided by recommendations from the Comptroller General. These recommendations, due by December 31, 2029, must consider impacts on various practice types, including small, rural, and underserved communities, and prevent unintended consequences. The system maintains budget neutrality by adjusting positive payment factors to offset negative ones. A significant provision establishes a mechanism to invest savings generated by the DPPS into lump-sum incentive payments for under-resourced small practices. These payments, available in "DPPS savings years" when aggregate decreases from low performers exceed increases from high performers, are intended to help practices improve care management, address social needs, implement EHR technology, and participate in value-based care models. The Secretary may prioritize practices in rural areas, health professional shortage areas, or medically underserved areas for these incentives.