CMS just proposed the strongest push into accountable care that independent practices have seen in years. It is buried in the CY2027 Physician Fee Schedule proposed rule, and most of the coverage is missing how big it is.
Here is what the rule actually proposes for the Medicare Shared Savings Program.
The headline: a 32% per-visit boost
The biggest item is a new modifier that pays clinicians participating in the Medicare Shared Savings Program or the upcoming LEAD ACO model a roughly 32% increase on their office visits. And it applies to the practice's whole panel, not only the patients attributed to the ACO. For an independent practice, that is real money on nearly every visit.
More reasons to join
- The top shared-savings rate in the Basic track rises from 50% to 60%.
- There is a benchmark growth adjustment for practices that are new to risk, so first-timers are not penalized for having no track record.
- Beneficiary assignment rules are being updated, including new primary-care service codes used for assignment.
- Traditional MIPS is proposed to phase out in favor of accountable-care participation.
Taken together, CMS is no longer nudging practices toward value-based care. It is paying them, and paying well, to make the move.
The barrier was never the incentive
Here is the part worth sitting with. The incentive to join an ACO has never been larger. But the incentive was never what held practices back. The barrier is the infrastructure: proving your quality performance, managing chronic patients between visits, closing care gaps, and having the data ready to report. Most independent practices would happily capture these dollars. They just are not set up to do the operational work that accountable care requires.
That gap, between the incentive and the infrastructure, is where practices win or lose in value-based care.
The clock is already ticking
There is a near-term catch worth flagging. The 2027 incentives are still proposed, but the decision to participate is not a 2027 decision. To join an ACO for the 2027 performance year, a practice generally needs to be on that ACO's participant list, which the ACO submits to CMS by August 1, 2026. If accountable care is on your radar for next year, that window is closing in a matter of days, not months.
What to do now
- If you are ACO-curious, model the 32% modifier against your Medicare panel. The number is often larger than practices expect.
- Get your quality and chronic-care performance documented now, so you are ready when the next application window opens.
- The proposed rule is open for public comment through September 14, 2026. If your practice has a stake in how it lands, weigh in.
How SmartOps Health helps
This is exactly the infrastructure gap SmartOps Health was built to close. We surface the care gaps and value-based dollars across every payer, close them with automated outreach and follow-through, and prove the performance that accountable care rewards, without your practice adding headcount. When the incentive is this large, the practices that have the operational side handled are the ones that capture it.
Want to see where your practice stands going into 2027? Get a free gap scan.