MGMA warns of government overreach in the proposed 2026 Medicare Physician Fee Schedule
The Medical Group Management Association (MGMA) is raising alarms over elements of the proposed 2026 Medicare Physician Fee Schedule, published by the Centers for Medicare & Medicaid Services (CMS) in July, that could shift how relative value units (RVUs) are determined—potentially sidelining physician input in the process.
"This type of document is 2,000 pages long and it's full of policies. It also sets the rates for the following year, but it often does so outside of what we usually talk about, like the conversion factor and the Medicare cuts, with relative value units (RVUs), where you have work RVUs, practice expense RVUs to deal with overhead costs, and malpractice RVUs,” explained Anders Gilberg, MGA, senior vice president, government affairs at the MGMA, in an interview with HealthExec.
According to Gilberg, CMS is proposing adjustments to work RVUs and practice expense RVUs that could redistribute funding from procedural and diagnostic specialties—such as cardiology and radiology—toward more time-based primary care specialties. While MGMA supports addressing the financial challenges facing primary care, the association is concerned about how these changes were developed.
Gilberg said some of the proposed cuts “were framed in such a way to be critical of the AMA and the fact that they may not have the full representation of their data set,” but argued that CMS’ alternative, across-the-board reductions, was “not based in… any kind of solid policy data.”
Currently, the American Medical Association’s Relative Value Scale Update Committee, which includes representatives from dozens of specialties and government officials, recommends RVU changes to CMS. While the process is not perfect, he said it allows for the AMA and other professional groups to make their voices heard in the process.
“I strongly doubt that most physicians in this country will ultimately want the federal government to take that process and turn it into a hyper-politicized, and possibly less data-driven process that doesn't have that relativity or the input from the many dozens of physician specialties that are actually doing the work," Gilberg explained.
Gilberg noted that the proposal could result in some physicians receiving the average 3.5% payment bump projected for 2026, while others could see cuts, depending on specialty. Since CMS needs to maintain budget neutrality, meaning it can only spend what it is allocated, to raise pay in one specialty as an incentive, it requires cuts elsewhere in the Medicare budget.
MGMA’s final comment letter is due at the end of August, and Gilberg urged physicians to also review guidance from their specialty societies.
“Our main concern would be the slippery slope we have towards government setting rates in a more comprehensive way for physicians and the implications of that,” Gilberg said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]