The
Centers
for
Medicare
&
Medicaid
Services
unveiled
a
proposed
rule
that
would
raise
Medicare
outpatient
payments
next
year,
as
well
as
introduce
a
key
change
to
how
physicians
are
reimbursed.
Provider
groups
aren’t
convinced
that
these
changes
would
benefit
them
in
the
long
run,
though.
The
rule,
which
was
released
last
week,
would
raise
Medicare
payment
rates
for
hospital
outpatient
services
by
a
net
2.4%
in
2026.
The
increase
reflects
a
3.2%
market
basket
update,
which
CMS
partially
offset
through
a
0.8%
productivity
adjustment.
The
agency
proposed
a
2.4%
payment
bump
for
ambulatory
surgery
centers
in
2026
as
well.
CMS’
proposal
also
introduced
two
distinct
conversion
factors
for
physician
payment
—
one
for
clinicians
participating
in
alternative
payment
models
and
another
for
those
who
aren’t.
This
change
stems
from
a
longstanding
provision
in
the
Medicare
Access
and
CHIP
Reauthorization
Act
of
2015
(MACRA),
which
is
aimed
to
shift
Medicare
away
from
fee-for-service
reimbursement
and
toward
value-based
care
by
encouraging
providers
to
participate
in
risk-bearing
payment
models.
In
other
words,
if
CMS’
proposed
rule
takes
effect,
the
agency
will
use
two
separate
conversion
factors
when
calculating
physicians’
payment
rates
hinging
on
their
participation
in
value-based
care
arrangements.
The
proposal’s
conversion
factor
for
doctors
in
alternative
payment
models
is
$33.59,
which
is
a
3.8%
year-over-year
increase,
and
the
conversion
factor
is
$33.42
for
doctors
not
in
these
models,
which
is
a
3.6%
hike.
The
American
Academy
of
Family
Physicians
said
it
is
heartened
by
this
payment
boost
—
but
worried
it
won’t
be
enough
to
help
providers
improve
their
margins
in
the
long
run.
“We
are
also
encouraged
that
CMS
proposed
to
increase
the
conversion
factor
for
2026
by
3.8%
for
qualifying
alternative
payment
models
and
3.6%
for
all
other
physicians.
However,
the
majority
of
the
increases
for
2026
are
temporary
adjustments
attributable
to
H.R.
1,
which
will
expire
at
the
end
of
the
year.
In
2027,
practices
will
face
another
pay
cut
and
struggle
to
keep
pace
with
inflation,”
the
group
said
in
a
statement.
The
American
Medical
Group
Association
also
voiced
concern
that
these
incremental
increases
fall
short
of
keeping
pace
with
inflation
and
rising
practice
costs
—
perpetuating
a
multiyear
decline
in
physician
reimbursement.
The
group
emphasized
that
emergency
fixes
are
not
enough
and
is
advocating
for
a
fundamental
overhaul
of
the
Medicare
physician
fee
schedule.
“Health
systems
and
medical
groups
continue
to
bear
the
brunt
of
an
outdated
and
underfunded
reimbursement
model,”
AMGA
CEO
Jerry
Penso
said
in
a
statement.
“Without
systematic
reform,
Medicare’s
current
fee-for-service
framework
will
remain
misaligned
with
the
shift
toward
high-value
care.”
Unless
CMS
enacts
comprehensive
reforms,
physician
groups
warn
that
temporary
payment
fixes
won’t
be
enough
to
protect
healthcare
access
or
providers’
financial
sustainability.
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