Physicians are facing rising workloads, shrinking support staff and declining reimbursement — resulting in a burnout crisis and threatening the sustainability of independent practices. Experts say urgent Medicare payment reforms are needed to prevent further consolidation, as well as preserve access to care.
CMS proposed a 2.4% Medicare payment increase for hospitals’ outpatient departments and ambulatory surgery centers in 2026, along with a new two-tiered physician reimbursement structure based on participation in value-based care models. Provider groups are welcoming the short-term boosts, but they fear the changes don’t go far enough to address their long-term financial pressures.
This eBook provides actionable strategies, real-world best practices to help payers stay ahead in a value-based care environment.
Congress released a stopgap funding bill with a significant healthcare package, and provider groups are reacting favorably. They are mainly applauding provisions that reign in PBMs’ business practices, extend telehealth flexibilities, and boost payments to hospitals and physicians.
High labor costs remain an ongoing problem threatening providers’ bottom lines, according to new data from Kaufman Hall. The research revealed that medical groups’ median investment in each employed physician has reached more than $300,000 for the first time.
CMS issued its proposed rule for next year’s Medicare physician fee schedule, revealing plans to cut payment rates by 2.8%. Industry groups swiftly expressed their outrage, arguing that reimbursement rates need to keep up with the pace of inflation.
CMS recently revealed its proposals to raise reimbursement rates for hospital outpatient departments and cut payments for physicians. Next year, the agency is planning to decrease physicians’ pay by 1.25% and increase outpatient payment rates by 2.8%. Provider groups are unhappy with the news — AMA President Dr. Jesse Ehrenfeld said the new physician fee schedule will be “almost biblical in its impact.”
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As MIPS and other performance-based payment programs evolve, providers eventually will be on the hook to cut checks if they can't perform. Individual providers must act now to stay on top of the distribution curve.
Site-neutral payments are a good thing in and of themselves. The last thing the healthcare industry needs is more profit-driven provider consolidation.