This week, ASCRS and the Alliance of Specialty Medicine met again with the staff of the Medicare Payment Advisory Council (MedPAC) to express our ongoing opposition to their recommendation to repeal MIPS and force physicians into Advanced APMs or a new “Voluntary Value-Based” (VVP) Program. As proposed, the VVP would withhold a portion of a physician’s Medicare reimbursements. To make the withhold back, physicians would have to join large, virtual groups and be evaluated on problematic “population health” measures. We reiterated our opposition to the recommendation, since most specialists, especially ophthalmologists, do not have any access to join APMs and that the proposed measures for the VVP have no relevance to specialty medicine. We continue to assert that Medicare must preserve a viable fee-for-service option, and noted the medical community’s efforts to increase participation in MIPS by advocating for changes, providing education to members, and sponsoring clinically relevant tools such as qualified clinical data registries (QCDRs). We have previously met with the MedPAC staff and commissioners, and sent several letters in opposition to their proposal. We will continue to press that it be removed.