House bill would ease ACO quality reporting through 2029

Accountable care organizations may soon get a clearer path for reporting the quality data tied to Medicare payment. A bipartisan House bill, the Health Care Efficiency Through Flexibility Act, H.R. 5347, would preserve current reporting options through 2029 and create a pilot program for digital quality measures. Supporters say the measure could reduce administrative burden for ACOs, especially for smaller, independent, and rural physician practices that have struggled with reporting demands.

The legislation was approved this week by the House Ways and Means Committee on a 43-0 vote and then passed the full House by unanimous consent. It is aimed at giving ACOs more stability in the Medicare Shared Savings Program, or MSSP, which requires organizations to meet quality standards in order to receive payment. For many physicians, the reporting process has become one of the most persistent and costly parts of participating in value-based care.

House Ways and Means Committee Chairman Rep. Jason Smith, R-Missouri, described the bill as a practical response to a problem that has gotten in the way of the program’s core purpose. He said ACOs are an important part of improving quality and lowering costs, but added that onerous reporting requirements leave health care providers with less time and fewer resources to focus on patient care. Smith said the bill would bring added certainty, clarity, and flexibility to the quality measure reporting system and make the move toward electronic data less expensive and less disruptive.

H.R. 5347 was introduced by Health Subcommittee Chairman Rep. Vern Buchanan, R-Florida, and Rep. Jimmy Panetta, D-California. The bill takes a two-part approach. First, it would lock in current quality measure reporting methods through 2029, giving ACOs a defined period to modernize without facing an abrupt regulatory shift. Second, it would establish a pilot program for digital quality measures, or dQMs, so organizations can test a more automated reporting approach before any broader transition is required.

The stability portion is significant because the Centers for Medicare & Medicaid Services has not provided a stable transition framework or a full timeline for moving ACOs to newer reporting systems. That uncertainty has made some organizations reluctant to invest in new technology. For physician practices within ACOs, the risk is straightforward: if the rules could change unexpectedly, spending heavily on new reporting systems may not make sense.

The digital quality measure pilot is intended to change how reporting is done. Instead of relying on separate manual submissions and abstraction processes, dQMs would draw data directly from electronic health records. That means quality information could be compiled from the systems physicians already use, reducing the need for dedicated reporting staff, outside vendors, and manual chart review.

The source article notes that traditional quality reporting can be expensive and labor-intensive. One health system reported spending more than $5.6 million on quality reporting in a single year, including more than $600,000 paid to outside vendors and more than 100,000 staff hours, as of 2018. In addition, some ACOs operate across more than 15 different electronic health record platforms, each with different technical capabilities, which makes standardizing data collection difficult.

Supporters of the digital approach say the potential savings are substantial. According to the source article, digital quality measures could be 95% less expensive to report than traditional quality measures, and estimates suggest the shift could produce up to $14 billion in national health care savings. Emily Brower, president and CEO of the National Association of ACOs, said the new approach would make quality reporting less burdensome. In a statement, she said it would align reporting requirements with efforts to improve care and reduce administrative costs, allowing physicians and other clinicians to devote more resources to patient care.

The legislation could be especially relevant for smaller independent practices. A practice with limited staff and a modest electronic health record system can face a disproportionate burden when reporting requirements take up more time and money relative to revenue. For those organizations, a move toward automated reporting could free up resources that can be redirected to direct patient care.

Mara McDermott, chief executive officer of the ACO advocacy organization Accountable for Health, said the bill strikes a balance by keeping multiple reporting options in place through 2029 while also creating a path toward more modern systems. In her view, the legislation recognizes both the promise of digital innovation and the limits of current health IT infrastructure. McDermott said ACOs want to be accountable for quality and outcomes, but the reporting rules need to be workable, consistent, and designed to support participation.

The bill has also drawn support from across the health care sector, including the American Academy of Family Physicians, the National Association of ACOs, and Aledade, which helps independent physician practices form and manage ACOs. The broad backing suggests that the reporting issue extends beyond any single type of organization and touches many providers working in value-based care.

The article also places the legislation in the larger context of MSSP performance. Since the program began 14 years ago, it has saved Medicare more than $12 billion. As of 2026, there are 511 ACOs involving 687,739 medical providers that care for more than 12.6 million traditional Medicare beneficiaries. More than 12,500 of those providers work at federally qualified health centers, rural health clinics, and critical access hospitals, which serve some of the country’s most medically underserved communities.

Even so, ACO models require sustained investment in infrastructure and compliance, and those costs do not fall evenly across participants. The article says that reporting burden is only one of several reasons smaller independent practices remain outside ACOs. Research published by The Commonwealth Fund found that primary care physicians without experience in value-based payment face a range of barriers to participation. That research was based on interviews and focus groups with 29 frontline physicians and primary care management experts.

A 2022 survey found that just 46% of primary care physicians reported receiving any value-based payments. Smaller and independent practices were least likely to participate, even though they collectively serve 39% of traditional Medicare beneficiaries. Experts told researchers that value-based care can feel like fee-for-service with an added layer of reporting and accountability that the system is not structured to support. Fee-for-service still dominates primary care revenue, so shifting time and resources toward value-based care can feel difficult when most income continues to depend on visit volume.

The Commonwealth Fund research also identified financial challenges. Smaller practices often receive smaller shared savings payments because they see fewer patients, yet they still face similar upfront costs for new workflows, staffing, and technology. Participants said practices with limited reserves cannot easily absorb a poor performance year, and they said upfront payments and protection from downside financial risk would make participation easier. For practices tied to larger health systems, the challenge can be different: some systems have joined ACOs on behalf of affiliated physicians but have not reliably passed resources down to the practice level.

Physicians in the research also criticized the current quality measures themselves. They said many measures are too narrow, focusing on individual conditions or binary screening cutoffs rather than the complexity of primary care. Measures tied to hospitalization rates and total Medicare spending were viewed as especially unfair because those outcomes are shaped by specialists and hospitalists outside a primary care physician’s direct control. Doctors said they would prefer measures that reflect access, continuity, and communication.

H.R. 5347 still needs to clear the Senate before it can become law. House supporters are hoping that the unanimous House passage will give the measure momentum. Buchanan said the legislation reflects the practical reality that ACOs need multiple reporting pathways during a transition to newer methods. In a statement, he said the bill would reduce excess regulatory burden and allow providers to focus on high-quality, value-based care. He added that he hopes the Senate will consider the measure and send it to the president to improve care, lower costs, and make life easier for patients and doctors alike.

The additional co-sponsors listed in the article are Rep. Dan Crenshaw, R-Texas; Rep. Darin LaHood, R-Illinois; and Rep. Mike Lawler, R-New York.