Medicare quietly lets ACOs hide quality data in new pilot program
H.R. 5347 — Health Care Efficiency Through Flexibility Act · Filed by Vern Buchanan (R-FL) · 4 cosponsors · Introduced Sep 15, 2025 · Passed chamber
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What it does
This bill modifies Medicare's Accountable Care Organization (ACO) program to give healthcare providers more flexibility in how they report quality measures to Medicare. Specifically, it requires Medicare to accept multiple data-collection methods (electronic clinical measures, MIPS measures, and others) for quality reporting through 2029, allows ACOs to exclude data from individual participants who cannot use a selected collection method without penalty, and establishes a pilot program (2028–2032) letting selected ACOs test new digital quality-reporting methods while being excused from reporting certain other measures. The bill appropriates $8 million for implementation and reduces the Medicare Improvement Fund by $2.054 billion.
Why we flagged it
The bill's core function is to reduce compliance burden on ACOs by expanding acceptable data-collection methods and creating a pilot that temporarily exempts participants from full quality-reporting requirements. While framed as 'efficiency,' the operative mechanism is regulatory flexibility and partial accountability waiver.
- Section 4 reduces the Medicare Improvement Fund by $2.054 billion—a budget offset unrelated to ACO reporting flexibility. This is a standard pay-for mechanism but substantively separate from the bill's stated purpose.
What the text implies
- The pilot program (2028–2032) allows selected ACOs to exclude certain quality measures from Medicare's performance assessment entirely. This creates a two-tier system where pilot participants face reduced scrutiny, potentially allowing lower-performing ACOs to hide poor outcomes if they are selected for the pilot.
- The 'data completeness' waiver (Section 2, clause 2) permits ACOs to submit incomplete data without penalty if a participant 'was unable to collect' data through the chosen method. This standard is subjective and unverifiable, creating a loophole for ACOs to exclude unfavorable data.
The full analysis lists 4 implications of this text.
Who stands to gain
Accountable Care Organizations (ACOs); Healthcare systems and hospital networks participating in Medicare Shared Savings Program; Health IT vendors providing electronic clinical quality measure systems