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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: AMA supports reforms that would stabilize the Medicare Economic Index and Alternative Payment Model. Clinicians can help facilitate change by sharing their real-world experiences with lawmakers. AMA recently reiterated its call for Congress to pass several reforms that would increase physician payment and improve health care accessibility. During a House Energy and Commerce Subcommittee on Health meeting in May, the AMA advocated for these reforms:
AMA supports reforms that would stabilize the Medicare Economic Index and Alternative Payment Model. Image: Adobe Stock
H.R. 6160, or the Strengthening Medicare for Patients and Providers Act, which would establish a permanent inflationary update tied to the Medicare Economic Index, \u201cclosing the gap between rising practice costs and stagnant Medicare physician payment\u201d; H.R. 8163, or the Provider Reimbursement Stability Act, which would protect the permanent inflationary update from a budget neutrality mechanism that is meant to balance Medicare physician spending; H.R. 8622, or the Medicare Physician Data-driven Performance Payment System Act of 2026, replacing the Merit-Based Incentive Payment System (MIPS), which adjusts payments according to performance measures, with a \u201cfair, stable and transparent performance program that would finally end the era of penalizing practices that see sicker, more vulnerable patients while giving the majority of incentive money to well-resourced systems\u201d; and permanently stabilizing the Alternative Payment Model (APM) incentive payment and pairing it with the Implementing Physician-Led Ambulatory Care Transformation (MPACT) program, which would offer grants to physicians to test innovative care approaches, according to the AMA. Physician payment has declined 33% since 2001, after adjusting for inflation, \u201cand physicians remain the only Medicare provider without an automatic annual inflationary payment update,\u201d an AMA press release said. \u201cMany physician practices, particularly in rural areas, are being forced to limit the number of Medicare patients they see or close altogether,\u201d according to the organization. In March, the Medicare Payment Advisory Commission recommended that Congress increase the payment update for physicians caring for Medicare patients in 2027 by 0.5% on top of the 0.25% and 0.75% updates to the APM \u2014 a payment system incentivizing high-quality care \u2014and nonqualifying APM conversion factors, respectively, in the current law. Flaws of the current system In an article published in Health Affairs, Christopher P. Childers, MD, PhD, an assistant professor at the University of Washington, and colleagues explained that the current system\u2019s budget-neutrality mechanism \u201cdoes not apply to Medicare pay systems for hospitals, ambulatory surgery centers or other institutional settings. As a result, any increase in primary care reimbursement must be offset by decreases elsewhere, creating an inherently competitive division between specialties united by a uniform professional commitment to patient care. \u201cCompounding this, the physician payment over which specialties are forced to compete represents one of the smallest shares of health care spending,\u201d they wrote. Meanwhile, complying with MIPS costs around $12,800 per clinician yearly and requires 202 hours of physician and staff time, AMA said. MIPS \u201cis disproportionately penalizing small, rural and independent practices that do not have the same resources as large practices and health systems to comply with the program\u2019s expensive and burdensome reporting requirements,\u201d the organization said. Feedback tied to MIPS is also failing, with physicians receiving feedback \u201cfor a given performance year up to 18 months after services were rendered, long after they can make meaningful adjustments,\u201d the AMA said. Stephanie Quinn, senior vice president of external affairs and practice experience at the American Academy of Family Physicians, told Healio that primary care is among the specialties facing the greatest strain from the current payment system \u201cbecause the Medicare payment system still does not reflect the full value of what family physicians do every day. \u201cThe current system pays largely by individual service or procedure, which means physicians must document and bill separately for many pieces of care \u2014 often while providing important work, like care coordination and patient counseling, that may not be fully recognized or paid for,\u201d she said. The current system also creates further instability, Quinn explained, because it \u201ccontinues to place higher value on procedures than on the cognitive, relationship-based care that is at the heart of primary care. \u201cThe result is a system that adds administrative burden, creates downward pressure on payment and makes it harder for primary care practices to remain financially sustainable,\u201d Quinn said. \u201cWhen payment does not keep pace with the cost of running a practice, independent physicians face growing pressure to sell to other large entities.\u201d Recent changes to the Medicare Physician Fee Schedule \u201care a step in the right direction, because they better recognize the higher overhead costs independent practices face compared with facility-based settings,\u201d Quinn said. However, \u201cbroader reforms are still needed to make independent practice a viable option and protect patients\u2019 access to care in their communities.\u201d How individual physicians can help According to Quinn, health care professionals can help push these reforms forward by sharing real-world examples \u201cof how Medicare payment instability affects their patients and practices. Policymakers need to hear what this looks like on the ground: longer wait times, fewer independent practice options and more difficulty recruiting new physicians into primary care.\u201d Specifically, health care professionals can respond to requests for comments about these reforms, speak with their professional medical societies and organizations, meet with policymakers \u201cand help explain why stable, sustainable payment is essential to patient access,\u201d Quinn said. If reforms are not enacted, \u201cpatients will likely face longer waits, fewer choices and less access to primary care, especially in rural and underserved communities,\u201d Quinn said. \u201cMore independent practices may be forced to consolidate or close, and some practices may no longer be able to accept<\/p>\n","protected":false},"author":1,"featured_media":3012,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3011","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3011"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3011\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3012"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}