Healthcare teams are reacting to CMS’ proposed 2026 Doctor Charge Schedule primarily with concern, arguing that it wants vital revisions so as to keep away from destabilizing suppliers and undermining value-based care momentum.
The proposal, issued in July, seeks to determine two new conversion elements — one for physicians in superior different fee fashions (APMs) and one other for many who aren’t. CMS plans to extend the APM charge by 3.83% in 2026, whereas the non-APM charge would go up by 3.62%.
These will increase replicate a number of elements — a small statutory bump (0.75% for APM members and 0.25% for others), an across-the-board 2.5% enhance required by latest laws, and an extra 0.55% adjustment tied to CMS’ proposed adjustments in doctor work relative worth items (wRVUs).
For 2026, CMS can be proposing to trim funds by making use of a 2.5% “effectivity adjustment” to sure wRVUs. Basically, CMS believes some providers could be delivered extra effectively, so it’s reducing the quantity of doctor work credited for these providers — wRVUs are central to how Medicare units fee charges, so this adjustment would successfully scale back reimbursement for a lot of affected codes.
As well as, the company’s plan seeks to decrease the oblique apply expense funds for providers carried out in hospital amenities, arguing that suppliers in these settings face decrease overhead prices than office-based practices. This alteration would scale back reimbursement for a lot of facility-based providers whereas barely boosting funds for care delivered in doctor workplaces.
CMS’ deadline for healthcare organizations to submit their feedback was September 12.
In its letter, the Medical Group Administration Affiliation (MGMA) voiced sturdy opposition to the fee charges included within the proposal. Whereas the group appreciates that CMS is proposing to extend the 2 newly launched conversion elements, “this doesn’t treatment earlier cuts that doctor teams have needed to take in because of flawed coverage, nor does it deal with potential future cuts because of funds neutrality,” MGMA wrote.
The group additionally pushed again on the effectivity adjustment to wRVUs and the cuts to oblique apply bills, saying each adjustments would unfairly penalize suppliers and speed up consolidation.
One other trade group — the Nationwide Affiliation of ACOs (NAACOS) — criticized CMS’ plan to mandate participation in its ambulatory specialty mannequin, which is a value-based care program geared toward integrating specialists into Medicare fee fashions for situations like coronary heart failure and again ache.
In its proposal, CMS stated participation can be necessary, with specialists’ funds tied to efficiency and affected person outcomes, overlapping with different applications just like the Medicare Shared Financial savings Program (MSSP).
“Requiring specialists in an ACO to take part will exponentially enhance administrative burden, create duplicative reporting necessities, and extra importantly, unintentionally discourage specialists from remaining in and becoming a member of superior APM preparations. At a minimal, suppliers which have certified supplier/partial certified supplier standing must be excluded from the mannequin or allowed to voluntarily opt-in to [the ambulatory specialty model],” NAACOS wrote in its letter.
Along with structural and fee considerations, healthcare teams are urgent CMS to make higher use of knowledge.
Premier referred to as on the company to make the most of knowledge from performance-based contracting preparations to raised inform protection and reimbursement selections for brand spanking new digital well being instruments.
“Premier encourages CMS to have interaction with SaaS distributors and supplier finish customers who’re already amassing and evaluating proof of the device’s impression on high quality enchancment and price effectiveness,” the corporate wrote.
Healthcare stakeholders will now wait to see how the company responds to those feedback and whether or not the ultimate rule will deal with the considerations they raised.
Picture: seksan Mongkhonkhamsao, Getty Photographs
