This bill replaces Medicare's current Merit-based Incentive Payment System with a new Data-driven Performance Payment System, effective January 1, 2027, to change how the federal government pays physicians based on their performance. Starting in 2028, doctors will receive fixed payment multipliers ranging from 0.5 to 1.25 times their base payment depending on whether they meet, exceed, or fall below performance thresholds, with Medicare required to provide quarterly feedback within 60 days. The legislation protects patients by preventing increased cost-sharing when physician payments are reduced due to performance adjustments and caps performance thresholds at 75 points through 2033. Savings generated from lower-performing physicians will be redirected as incentive payments to small practices with 15 or fewer doctors in rural and underserved areas to support quality improvement efforts. The bill also requires the Comptroller General to recommend a new methodology for setting future performance thresholds by December 2029.