The proposed 2027 Medicare fee schedule includes a 1.68% conversion factor cut for physicians outside an alternative payment model and 1.19% for those inside one. This is the fifth straight year the rate has been under threat, and for independent practices paid almost entirely under the fee schedule, the math is getting harder to absorb.
Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, has spent years pressing Congress and CMS to overhaul the way Medicare pays physicians.
The proposed rule, released in July, reaches well beyond the conversion factor, from the budget neutrality requirements that force cuts in one specialty to fund another to the phaseout of traditional MIPS. Gilberg explains what practice leaders should watch before comments close Sept. 14.
CMS is accepting public comments on the proposed rule through Sept. 14. The proposed rule carries significant changes, including a tilt toward value-based care and the budget neutrality rules driving specialty-by-specialty shifts. They are concerned about the impact on independent practices.
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After repeated last-minute patches, Gilberg describes the pressure on independent practices and the pull toward consolidation. The 2.5% patch expires Dec. 31, and Gilberg discusses the newly introduced Patients First Act and why the real fix is legislative. The Medical Group Management Association backs a reform bill instead.
The rule highlights the problem of budget neutrality rather than fixing it, and which specialties stand to get hurt. Gilberg also discusses CMS’s 20-year-old data and the AMA process, noting the agency wants to move away from the AMA’s valuation process without new data to justify it. It is a significant concern for small and rural practices.
A proposed change to modifier 25 could cut payment when an office visit and a procedure fall on the same day. Comments are due Sept. 14, but Gilberg has seen little movement between proposed and final rules under this administration. The cumulative administrative burden of the rule’s moving pieces is a concern.
Whether Congress averts the cut, the year-end extenders, and the lame-duck session ahead are all uncertainties. The next fiscal cliff is a concern, and Gilberg discusses the potential implications for physicians and practices.
