Last chance to urge Congress to protect Medicare physician payment

Congress is almost done for the year. With year-end legislation looming, this is our last chance to enact meaningful legislation. The American Medical Association is urging physicians to contact their representative and senators and ask them to include three Medicare physician payment priorities in an end-of-year legislative package:

1. Extend the 2.5 percent Medicare physician payment update through 2027.
2. Enact the bipartisan Provider Reimbursement Stability Act (H.R. 8163/S. 5180).
3. Delay the modifier 25 payment reduction for one year.

Together, these provisions would provide needed near-term stability while advancing broader Medicare payment reform. Medicare physician payment is falling further behind the cost of care.

According to the American Medical Association, when adjusted for inflation, Medicare reimbursement for physician services has declined 33% from 2001 to 2026. The physician fee schedule is also the only major Medicare payment system without automatic inflation-based updates. That problem is getting worse. CMS projects that the cost of running a medical practice will rise another 2.6 percent next year. And CMS just finalized yet another cut: starting Jan. 1, Medicare will reduce payment when a physician provides a separately identifiable office visit and a minor procedure on the same day. A one-year delay would keep this new cut from adding to the strain on practices. Without congressional action, practices will face even greater financial strain, putting access to care at risk for Medicare patients, especially in rural and underserved communities.

Congress must also fix a major flaw in the payment system. When Medicare overestimates how often a new or updated service will be used, it cuts payment across the board for all physician services to offset spending that never actually occurs. Under current law, those mistakes are never corrected, so the cuts become permanent.

The Provider Reimbursement Stability Act would fix that by requiring CMS to correct these errors using actual data. The House Ways and Means Committee has already approved the bill unanimously, 44-0, and that's momentum we can use!

Take action now: Contact your representative and senators and urge them to include these three priorities in an end-of-year legislative package.

The first two provisions are important steps toward the broader reforms in the bipartisan Patients First Act (H.R. 9693). The Patients First Act includes this same budget neutrality fix plus automatic, inflation-based updates. Acting now would help lay the foundation to finish the job next Congress.

Physicians need a stable Medicare payment system to keep caring for patients in their communities.