Today, during its monthly meeting, the Medicare Payment Advisory Commission (MedPAC) discussed long-term issues confronting ACOs. During the discussion, commissioners continued to advocate that more physicians participate in ACOs due to potential cost savings and the potential for better patient outcomes through care coordination. Commissioners again mentioned the difficulty many specialists have, not only in participating in the management of ACOs, but participating in ACOs in general, but did not provide specific recommendations to remedy that. While all commissioners expressed support for the ACO model, some went so far as to recommend that all physicians be required to participate in ACOs in the future as a means of ending traditional Medicare fee-for-service, and discontinuing MIPS, which they view as a flawed system. ASCRS and the Alliance of Specialty Medicine have already met with MedPAC and sent several letters expressing our opposition to its recommendation to repeal MIPS and move physicians into Alternative Payment Models (APMs) or force them to join virtual groups measured with problematic population health measures. We are working to set up another meeting with MedPAC in the near future.