Consolidation, reimbursement and administrative burdens were among the biggest challenges for independent physicians in 2025.
The American Independent Medical Practice Association is targeting several key points of advocacy in the year ahead to address these concerns, David Eagle, MD, president of AIMPA, told Becker’s.
Expanding awareness of new ownership models
“Educating policymakers about the [management services organization] model,” Dr. Eagle said regarding the organization’s top priorities for 2026. “There’s been criticism of that model — I think some people see that as consolidation, but they missed the point. We’ve already consolidated so much care under the hospital [model] and MSOs are really a vehicle for maintaining independent practices.”
Becker’s has reported on at least 13 MSOs in 2025 alone that aim to empower physicians and keep practices independent, provide them with the resources they need to avoid traditional acquisitions and assist them as they struggle under increasing operational costs and declining reimbursements.
According to a 2024 survey by Bain & Co., 81% of physicians working in physician-led organizations reported satisfaction with their involvement in strategic decision-making, compared with just 50% in hospital-led practices.
While employed models still dominate the physician workforce, a new era of ownership is being made possible by a wave of MSOs, joint ventures and hybrid-ownership models are revolutionizing the way that physicians engage with practice ownership.
Physician fee schedule
CMS issued its final policy changes for Medicare payments under the Physician Fee Schedule — including a 3.77% increase from the current conversion factor. While some said that the increase was a “step in the right direction,” many physicians, including Dr. Eagle, said the boost did little to make up for decades of reimbursement cuts for independent physicians.
“The fee schedule is just a fundamental issue,” he said. “There’s just no way around it. The budget neutrality rules in the fee schedule are just so problematic over time that are going to need some relief. So that’s a priority of ours.”
The American Medical Association issued a statement Nov. 2 cautioning that although CMS’ final rule “includes a vital, one-time 2.5% update and critical telehealth provisions, other components of the rule may have unintended consequences for patients and private physician practices across the country.”
“That physicians are not facing a reduction in reimbursements — as we have in the past — is a significant positive for 2026 and a win for patients’ access to care. Yet, this one-time correction does not keep up with increasing costs, and private practices across the country are expressing concern this rule would further put them at a disadvantage merely for treating patients at a hospital or ambulatory surgery center,” AMA President Bobby Mukkamala, MD, said in the statement. “As the new rule is implemented and its changes are felt, we will share with CMS the real-world impacts — data and details not always easily available to policymakers in Washington. This exchange and collaboration are vital to keeping practices open during a physician shortage.”
Site-neutral payments
“In a time where there’s so much pressure in the healthcare system, and you’ve got a public that really needs affordability in their lives, I think site neutral payments are something that just makes sense,” Dr. Eagle said.
Site-neutral payment policies, which would require Medicare to pay the same rate for a service regardless of where it’s delivered, have been a policy focus for years. Lawmakers argue that the current system encourages hospitals to acquire physician practices to capture higher reimbursement, driving up both Medicare costs and patients’ out-of-pocket spending.
CMS is currently advancing a major step toward site-neutral payment reform in its 2026 Hospital Outpatient Prospective Payment System rule. By equalizing reimbursement across hospital outpatient departments, ASCs and physician offices, policymakers aim to reduce spending.
Downcoding and other payer issues
While physicians face an array of payer-related issues, Dr. Eagle said that downcoding has emerged as a major thorn in the side of physicians.
“A new issue is insurer downcoding. Based on their algorithm, they’ll downcode a visit by one level, but they know they’re doing it wrong,” he said. “They’re doing it based on the claim form, and the claim form is not the medical record.”
He added that while insurers are “completely within their rights” to review medical records and ensure that codes have been properly placed, the current practice “puts the burden on the physicians to go in after the fact and get proper payment,” which is especially burdensome for smaller practices.
“That’s just an example of bad faith insurer practices, and I think that’s a problem,” Dr. Eagle said. “We’re seeing a lot of more difficulty with prior authorization, and then insurers just not paying claims that are filed cleanly. So I think those are issues that we will need to pay attention to.”
