Commentary: A Physician's Perspective on Medicare Physician Payment Reform

The Annual Cycle Continues

As a physician who spent more than a decade on the floor of Congress fighting for fair physician reimbursement, I look at the proposed 2027 Medicare Physician Fee Schedule cut with a familiar sense of frustration, but also cautious resolve.

We've seen this movie before. Year after year, temporary patches to the conversion factor expire, and physicians are once again staring down a scheduled cut just to keep their doors open to Medicare patients, even as practice costs keep climbing. That's not sustainable, and it's not what Congress intends when it talks about protecting seniors' access to care.

The good news is that Congress has a track record of stepping in at the eleventh hour to blunt or delay these cuts as it did with prior scheduled reductions. I expect we'll see the same bipartisan muscle memory kick in again this year with physician and healthcare professional organizations mobilizing, members of both parties hearing from constituents back home and a short-term patch getting attached to a larger legislative vehicle before year's end. That's the pattern, and I'd be surprised if 2027 breaks it. Whether through an end-of-year legislative package or another must-pass vehicle, Congress has repeatedly demonstrated that there remains bipartisan recognition that allowing significant physician payment reductions to take effect risks undermining beneficiary access to care.

Moving Beyond Annual Payment Patches

But a patch is not a policy. The harder, and more important, fight is for structural reform, and there's real reason for optimism on that front. Reps. John Joyce, M.D. (R-Pa.), Greg Murphy, M.D. (R-N.C.) and Kim Schrier, M.D. (D-Wash.), who chair the GOP and Democratic Doctors Caucuses, recently introduced the bipartisan Patients First Act, comprehensive Medicare Access and CHIP Reauthorization Act (MACRA) reform legislation that would:

• tie physician reimbursement to an inflationary measure
• establish a primary care hybrid payment pilot program that pays primary care physicians (PCPs) a per-member-per-month payment along with regular services, better capturing the work PCPs do
• establish the Patient Outcome Improvement National Tabulation System (POINTS) program, which creates a physician and clinician-led task force at Centers for Medicare & Medicaid Services (CMS) to develop quality metrics that are streamlined and reduce administrative burden
• freeze advanced alternative payment model (A-APM) participation thresholds for three years and create notice and comment periods for CMMI mandatory models
• reform Medicare Physician Fee Schedule (MPFS) budget neutrality by requiring more frequent input updates and CMS to validate its utilization assumptions with actual claims data

Why the Patients First Act Matters

Having three doctors from across the aisle co-author this bill matters enormously. It's the kind of clinician-led, bipartisan coalition that has historically been necessary to move entrenched Medicare payment policy. Importantly, these members have firsthand experience caring for patients and understand the disconnect between physician practice costs and Medicare reimbursement. The challenge, as always, is finding budgetary offsets and building enough momentum to get a comprehensive bill such as this across the finish line rather than watching it stall in committee.

Looking Ahead

As a dose of reality, however, I don't expect the Patients First Act or comparable comprehensive reform to become law this year. Bills such as this typically take multiple Congresses to build the coalition and offsets needed for passage. That said, the fact that it's being led by three physician-legislators from both parties, and that it squarely addresses the perennial problems in the MPFS, gives me more confidence than I've had in some time that we're finally moving toward a durable fix rather than another one-year band-aid.

In many respects, the proposed rule underscores why this conversation cannot wait much longer. Though CMS can make important technical improvements to payment methodology through regulation, only Congress can address the underlying statutory payment framework that continues to produce annual instability. The proposed rule therefore serves as another reminder that meaningful physician payment reform ultimately requires congressional action rather than annual regulatory adjustments. It will take sustained pressure from the physician and healthcare professional community, continued education of members and staff, and a willingness to compromise on financing mechanisms. I remain optimistic that we will get there, but it will be a multiyear effort.

Holland & Knight Senior Policy Advisor Larry Bucshon, M.D., is a former member of the U.S. House of Representatives (R-Ind.) and vice chair of the GOP Doctors Caucus.