3 Critical Takeaways from the 2026 PFS Proposed Rule Every ACO Should Know

The CMS 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule is here, and while the industry has already dissected the headlines—new benchmarks, quality measure lists, and continued EUC policies—there are quieter, yet critical, changes tucked deep within the 1,800-page document that could significantly impact ACO operations in 2026 and beyond.

We dug in to uncover three key implications that might not be making the rounds in your inbox but could have big consequences for how ACOs report quality and drive success in value-based care.

1. Web Interface: Gone for Good

For ACOs holding out hope that the Web Interface might be revived for 2025 reporting, CMS has delivered a clear (if subtle) message: it’s officially sunset. Despite recent legislative discussions hinting at a return, there is no mention of retroactive support in the proposed rule.

For ACOs still transitioning, this shift raises concerns, but Azara is ready. Azara DRVS supports both eCQM and Medicare CQM pathways, integrates with 40+ EHRs, and uses a Master Patient Index (MPI) to unify records across providers. Automated, measure-ready tools and real-time performance dashboards make DRVS a powerful alternative to the retired Web Interface—ensuring seamless, compliant reporting without disruption.

Azara’s flexible, pre-validated eCQM platform enables ACOs to aggregate and normalize data from multiple sources, apply certified logic, and monitor performance across all participating entities—minimizing manual work while maximizing accuracy.

2. New Medicare CQM Patient Eligibility Criteria: A Step Forward—With Caveats

CMS is proposing that, starting in 2026, only patients who had a primary care visit within the past 12 months with an ACO participant will be eligible for inclusion in Medicare CQM reporting. This narrows the denominator by excluding patients with only specialist visits—an improvement in accuracy and relevance.

But this revision also raises operational challenges. Most EHRs are not equipped to segment this refined population, leaving ACOs unsure who exactly should be in their denominator. CMS’s proposed solution, providing a quarterly list of eligible patients from claims data, is too delayed to meaningfully guide reporting.

Azara DRVS helps solve this problem by synthesizing data across disparate systems, providing near real-time visibility (24-hour delay) into eligible populations, and aligning them with Medicare CQM quality reporting requirements. Our robust certified calculation logic and attribution capabilities allow ACOs to confidently know who to track, when, and how.

Additionally, DRVS enables ACOs to stratify performance by provider, site, or measure, helping teams prioritize action and close gaps faster. Whether you're working with a single system or a multi-EHR network, DRVS centralizes your view, giving you the operational intelligence needed to stay compliant and competitive.

3. A Quiet Signal: MIPS CQM Next to Go?

Tucked within the rule is another subtle signal from CMS—indicating CMS’s plans to remove the MIPS CQM collection type for ACOs starting with the 2027 performance year. For ACOs still using MIPS CQMs as your quality data collection method, this should be viewed as a continued warning. Forward-thinking organizations will need to plan for a full transition to the eCQM collection method, which will require different workflows, data aggregation, and reporting infrastructure.

Azara’s flexible data integration model and eCQM-ready platform are designed to future-proof your ACO against shifting policy landscapes, allowing you to focus on delivering better care, not chasing measure specs. DRVS not only helps streamline the reporting transition but also enables ongoing performance monitoring, documentation improvement, and intervention tracking—all key to thriving under new models.

How Azara Supports ACOs in Navigating Change

With regulatory expectations evolving, Azara Healthcare remains committed to helping ACOs stay ahead. Whether you’re preparing for your first Medicare CQM/all patients all payers quality submission, tackling complex attribution logic, or integrating data across EHRs, HIEs, and payers—Azara DRVS delivers the visibility, accuracy, and agility needed to succeed in MSSP and other VBC programs.

From pre-submission quality dashboards to patient-level drill-downs and centralized data aggregation, DRVS empowers ACOs to reduce reporting burden, identify opportunities, and operationalize quality across the network. Our advanced analytics help illuminate blind spots, monitor progress toward benchmarks, and prioritize action where it matters most.