CMS issued its final policy changes for Medicare payments under the Physician Fee Schedule — including a 3.77% increase from the current conversion factor.
Three physician leaders joined Becker’s to discuss their views on the new policy.
Editor’s note: These responses were lightly edited for clarity and length.
Question: How do you feel about CMS’ 3.77% boost to the physician fee schedule? What do you wish were different about the proposal?
Alan Falkoff, MD. Family Medicine Physician at Stamford (Conn.) Health: Little focus to support and promote primary care. Even less focus to support private practice. The physician “pay boost” will never reach the physicians. The top administrations of hospitals and large organizations are wringing their hands in glee.
The 3.7% is a step in the right direction, but as a private primary care physician, it is hardly enough to offset increases in rent and employee salaries and will only reduce access by driving more of us into concierge practices.
With respect to the decrease in specialist reimbursement, the same applies as more of them are also going concierge. You can’t reduce reimbursement by 6% to 7% and give back half of that and call it a raise. If medical care is determined to be a right, the government needs to pay for it.
Margaret Clarke Tracci, MD. Vascular Surgeon at University of Virginia Department of Surgery (Charlottesville): The fact of the matter is that after 20-plus years of payment failing to keep up with inflation, the services of all physicians are undervalued.
The agency has focused on increasing payment for primary care services, and this year’s boost comes on the heels of modest increases over the past several years. Unfortunately, we can’t seem to move past a fixed pie model where the total pool of funds has not grown with inflation or the demand for services. So these increases have come at the cost of reductions to surgeons and other specialists. The public is feeling the impact of these decisions on access, as wait times for an appointment — or even finding a physician — become more and more of a struggle.
George Williams, MD. Ophthalmologist at Illinois Society of Eye Physicians & Surgeons (Vernon Hills) and Diplomate of the American Board of Ophthalmology: Under the Medicare Access and CHIP Reauthorization Act of 2015, CMS must implement two conversion factors starting in 2026. The final 2026 fee schedule has an estimated 3.3% increase to Medicare payments for physicians who do not participate in Advanced Alternative Payment Models. CMS finalized a 3.8% increase for qualifying APM [alternative payment model] participants. Both conversion factor updates are driven by the one-year 2.5% Medicare payment increase in 2026 that was included in the Republican budget reconciliation legislation passed last summer, small positive payment adjustments provided by MACRA, and a small positive budget neutrality adjustment. Since most ophthalmologists cannot participate in an APM, the 3.3% increase will apply.
Conversion factor updates affect each specialty differently. The effect on individual ophthalmologists will be determined by the mix of procedures they perform and their APM participation status.
Keep in mind that the conversion factor updates in this rule reflect the temporary 2.5% Medicare payment increase that was included in the Republican budget reconciliation legislation, which will expire at the end of 2026. Unfortunately, there is no continuing inflationary increase as recommended by MedPAC in recognition of the more than 30% decrease in inflation-adjusted physician payment since 2000.
