Healthcare teams are reacting to CMS’ proposed 2026 Physician Fee Schedule primarily with concern, arguing that it wants vital revisions with a view to keep away from destabilizing suppliers and undermining value-based care momentum.
The proposal, issued in July, seeks to determine two new conversion elements — one for physicians in superior various cost fashions (APMs) and one other for individuals who aren’t. CMS plans to extend the APM fee by 3.83% in 2026, whereas the non-APM fee would go up by 3.62%.
These will increase mirror a number of elements — a small statutory bump (0.75% for APM members and 0.25% for others), an across-the-board 2.5% improve required by current laws, and an extra 0.55% adjustment tied to CMS’ proposed adjustments in doctor work relative value units (wRVUs).
For 2026, CMS can be proposing to trim funds by making use of a 2.5% “effectivity adjustment” to sure wRVUs. Basically, CMS believes some companies might be delivered extra effectively, so it’s reducing the quantity of doctor work credited for these companies — wRVUs are central to how Medicare units cost charges, so this adjustment would successfully scale back reimbursement for a lot of affected codes.
As well as, the company’s plan seeks to decrease the oblique apply expense funds for companies carried out in hospital services, arguing that suppliers in these settings face decrease overhead prices than office-based practices. This variation would cut back reimbursement for a lot of facility-based companies whereas barely boosting funds for care delivered in doctor places of work.
CMS’ deadline for healthcare organizations to submit their feedback was September 12.
In its letter, the Medical Group Management Association (MGMA) voiced sturdy opposition to the cost charges included within the proposal. Whereas the group appreciates that CMS is proposing to extend the 2 newly launched conversion elements, “this doesn’t treatment earlier cuts that doctor teams have needed to take in as a consequence of flawed coverage, nor does it deal with potential future cuts as a consequence of finances neutrality,” MGMA wrote.
The group additionally pushed again on the effectivity adjustment to wRVUs and the cuts to oblique apply bills, saying each adjustments would unfairly penalize suppliers and speed up consolidation.
One other trade group — the National Association of ACOs (NAACOS) — criticized CMS’ plan to mandate participation in its ambulatory specialty mannequin, which is a value-based care program aimed toward integrating specialists into Medicare cost fashions for situations like coronary heart failure and again ache.
In its proposal, CMS stated participation could be obligatory, with specialists’ funds tied to efficiency and affected person outcomes, overlapping with different packages just like the Medicare Shared Savings Program (MSSP).
“Requiring specialists in an ACO to take part will exponentially improve administrative burden, create duplicative reporting necessities, and extra importantly, unintentionally discourage specialists from remaining in and becoming a member of superior APM preparations. At a minimal, suppliers which have certified supplier/partial certified supplier standing ought to be excluded from the mannequin or allowed to voluntarily opt-in to [the ambulatory specialty model],” NAACOS wrote in its letter.
Along with structural and cost considerations, healthcare teams are urgent CMS to make higher use of knowledge.
Premier referred to as on the company to make the most of knowledge from performance-based contracting preparations to higher inform protection and reimbursement choices for brand spanking new digital well being instruments.
“Premier encourages CMS to interact with SaaS distributors and supplier finish customers who’re already amassing and evaluating proof of the device’s affect on high quality enchancment and price effectiveness,” the corporate wrote.
Healthcare stakeholders will now wait to see how the company responds to those feedback and whether or not the ultimate rule will deal with the considerations they raised.
Picture: seksan Mongkhonkhamsao, Getty Photos
