Medicare physician payment: we need to stop treating a 30-year structural problem like an annual emergency
TL;DR: Yes, comment on the 2027 CMS proposed rule. The immediate dollars matter. But even if physicians win every argument in this year's comment period, we have not fixed Medicare physician payment.
The deeper problem is statutory. Congress has created a physician payment system that does not reliably keep pace with the cost of running a medical practice and that can impose additional conversion-factor reductions through budget neutrality. Congress then periodically gives us temporary relief, the relief expires, and we mobilize again.
For once, there are bipartisan bills already in Congress that address major pieces of the structural problem.
That is where I think physicians — private practice AND employed — need to focus.
First: this is not just about the proposed 2027 cut
CMS is currently taking comments on the 2027 Physician Fee Schedule through September 14, 2026. We should absolutely comment where CMS has regulatory discretion. The proposed rule matters. (Centers for Medicare & Medicaid Services)
But we need to understand what a successful comment campaign can and cannot accomplish.
The fundamental Medicare physician update mechanism is established by federal statute. CMS administers that law. CMS can change many details of the fee schedule, but it cannot simply decide on its own that physicians will receive a permanent annual inflation adjustment if Congress has not put one into the statute.
This is why we keep seeing some variation of the same cycle:
Payment falls behind practice costs → physicians protest → Congress gives temporary relief → temporary relief expires → another cut appears → physicians protest again.
Even if CMS substantially improves the 2027 final rule, if the underlying statute remains unchanged, we are setting ourselves up for another version of the same fight.
So:
Comment on 2027. But don't confuse winning 2027 with fixing Medicare physician payment.
What would actually constitute a long-term fix?
At minimum, I think there are two structural problems that have to be addressed.
1. Physician payments need a permanent inflation adjustment
If staff wages, supplies, rent, insurance, technology and other practice expenses rise every year, physician reimbursement cannot sustainably remain essentially disconnected from those costs.
The relevant inflation measure already exists: the Medicare Economic Index, or MEI, which measures changes in the costs of providing physician services.
We should not have to return to Congress every year asking for another temporary percentage increase.
2. Budget neutrality needs major reform
Under the Physician Fee Schedule, sufficiently large increases in projected spending resulting from changes in relative values or services generally have to be offset elsewhere.
That means CMS can increase reimbursement for certain services while reducing the conversion factor to maintain budget neutrality.
Physicians end up fighting each other over shares of a constrained pool.
Budget neutrality does not necessarily need to disappear completely, but its current mechanics can create large and sometimes inaccurate reductions and need substantial reform.
The important part: Congress already has bills addressing this
This is why I don't think the message should simply be "write Congress and tell them Medicare reimbursement is too low."
They know.
There are actual bills physicians can ask them to move and improve.
H.R. 9693 — Patients First Act of 2026
This is probably the most important comprehensive bill currently on the table.
It was introduced July 15 by a large bipartisan group, led by physician members of Congress including John Joyce, MD, Greg Murphy, MD, and Kim Schrier, MD. It has been referred to both the House Energy & Commerce Committee and Ways & Means Committee. As of August 17, it has not yet cleared those committees or received a House floor vote. (GovInfo)
Read H.R. 9693 — official GovInfo text
This bill is significant because it addresses both inflation-linked updates and important Medicare payment-system reforms.
But there is a major gap.
For most physicians, its permanent update would generally be based on:
MEI minus 1 percentage point, with additional floors and ceilings.
In other words, it finally links physician reimbursement to practice-cost inflation — but it still deliberately allows physician reimbursement to trail that inflation over time. (GovInfo)
That is much better than what we have now.
But if our goal is to stop another 20 or 30 years of inflation-adjusted reimbursement erosion, partial inflation protection does not completely solve the problem.
H.R. 6160 — Strengthening Medicare for Patients and Providers Act
This bill contains the cleaner inflation solution.
It was introduced by Raul Ruiz, MD (D-CA), Gus Bilirakis (R-FL), Jimmy Panetta (D-CA), Ami Bera, MD (D-CA), and Kim Schrier, MD (D-WA).
It simply provides that the annual physician conversion-factor update should equal 100% of the estimated increase in MEI. (GovInfo)
Read H.R. 6160 — official GovInfo text
That is much closer to what physicians should ultimately want:
If the cost of providing physician services rises with MEI, physician reimbursement rises with MEI.
The problem is momentum. H.R. 6160 was introduced in November 2025 and referred to Energy & Commerce and Ways & Means, but it has not advanced nearly as far legislatively. (GovInfo)
H.R. 8163 / S. 5180 — Provider Reimbursement Stability Act
These bills attack the other major problem: budget neutrality.
Among other things, the legislation would:
- raise the extraordinarily low budget-neutrality threshold;
- index that threshold going forward;
- require corrections for certain CMS utilization estimates when actual experience proves materially different;
- require periodic updates to direct practice-expense inputs such as clinical staff wages, supplies and equipment;
- limit large year-to-year conversion-factor changes attributable to budget neutrality. (GovInfo)
There is actually meaningful bipartisan momentum here.
H.R. 8163 was approved by the House Ways & Means Committee in May. The official Congressional Record confirms that it was ordered reported as amended. (GovInfo)
Its bipartisan Senate companion, S. 5180, was introduced July 30 by John Boozman (R-AR), Peter Welch (D-VT), Roger Marshall, MD (R-KS), Angus King (I-ME), Thom Tillis (R-NC), and Jeanne Shaheen (D-NH), and has been referred to the Senate Finance Committee. (GovInfo)
Read S. 5180 — official GovInfo text
But this legislation does not itself provide permanent full inflation protection.
So budget-neutrality reform alone is not enough either.
What should physicians actually be asking Congress for?
This is where I think our advocacy needs to become much more precise.
Instead of:
>
Ask for something closer to this:
>
That is an actual legislative objective.
In simplified terms, the destination should look something like:
**H.R. 9693's broader structural reforms
- H.R. 8163/S. 5180's budget-neutrality protections
- H.R. 6160's full-MEI inflation update.**
If Congress enacted that combination, we would have gone a very long way toward fixing the recurring structural problem.
There would still be fights over individual RVUs, specialty redistribution, practice-expense methodology, MIPS, coding policy and other issues.
But those would be very different fights from starting every year with the entire physician fee schedule losing purchasing power.
Private-practice physicians: this obviously affects us
Those of us in private practice see the problem immediately.
Our employees expect raises.
Health insurance increases.
Rent increases.
Medical supplies increase.
Software increases.
Malpractice and other insurance increase.
Almost nobody calls and tells us:
"Because Medicare didn't increase your conversion factor enough this year, we have decided not to raise our prices."
When reimbursement grows slower than expenses, the difference eventually comes out of physician income, staffing, access, investment in the practice, increased volume — or the decision to sell or close.
Private practices cannot absorb that indefinitely.
But employed physicians should not assume this is someone else's problem
I think this deserves much more attention.
If you are employed by a hospital, health system, PE-backed group, academic center or other large organization and your salary looks fine today, do not confuse insulation with immunity.
Your employment contract may shield you from a Medicare cut this year.
Your paycheck does not necessarily fall 2% because the conversion factor falls 2%.
But the professional revenue generated by physicians still matters to the economics of employing physicians.
Employment largely changes who absorbs the reimbursement loss first.
If the gap between physician professional revenue and the cost of employing physicians keeps widening, eventually that pressure has to show up somewhere:
- compensation formulas;
- wRVU conversion rates;
- productivity expectations;
- staffing levels;
- APP ratios;
- support staff;
- appointment length;
- administrative burden;
- bonuses;
- recruitment;
- service-line subsidies;
- or bargaining power when contracts are renewed.
Not necessarily immediately. Not necessarily dollar-for-dollar.
But employment does not repeal the economics.
Hospital systems may have facility revenue and other sources of income that allow them to absorb physician professional losses much longer than an independent practice can. That is precisely why persistent underpayment of independent physician services can accelerate consolidation.
So employed physicians have a stake in fixing this too.
A physician workforce increasingly dependent on a handful of large employers because independent practice is economically nonviable is not a victory for employed physicians. It ultimately reduces physician bargaining power.
So what can an individual physician actually do?
1. Comment on the 2027 CMS proposed rule — but understand the objective
The deadline is September 14, 2026. (Centers for Medicare & Medicaid Services)
CMS 2027 Physician Fee Schedule proposed rule and comment information
Comment on areas where CMS has regulatory discretion.
But don't stop there.
A favorable final rule does not replace statutory reform.
2. Find your House member and contact them
Official House "Find Your Representative" tool
Don't send:
"Please protect doctors from Medicare cuts."
Ask specifically:
Will you support and help advance H.R. 9693?
Will you support strengthening the permanent physician update toward 100% MEI as proposed in H.R. 6160?
Will you support the budget-neutrality reforms contained in H.R. 8163?
And if your representative already supports these bills, don't simply thank them.
Ask:
What are you doing to get them through committee and onto the floor?
Cosponsoring a bill that quietly dies at the end of Congress is not the same as enacting it.
3. Contact both of your senators
Official U.S. Senate contact directory
Ask them to support and move S. 5180 through Senate Finance, while making clear that budget-neutrality reform needs to be paired with a permanent inflation-based physician update.
Again, be specific.
The goal is legislation, not another statement saying everyone agrees physician reimbursement is a problem.
4. If one of your legislators sits on the relevant committees, your voice matters even more
The key committees are:
House Ways & Means
House Energy & Commerce
Senate Finance
Those committees can determine whether these bills ever get close to a floor vote.
A constituent physician contacting a committee member is more useful than another national form letter sent indiscriminately to 535 offices.
5. Ask your specialty society what it is actually prioritizing
Most of us pay dues to multiple organizations.
Ask them:
Where do H.R. 9693, H.R. 6160 and H.R. 8163/S. 5180 rank among your legislative priorities?
How much lobbying effort and PAC activity are being directed toward getting structural Medicare reform enacted?
Are you pushing for full MEI, or are you prepared to accept permanent below-inflation updates?
Which legislators are helping move these bills, and which are preventing movement?
Physicians have limited political capital.
If permanent Medicare payment reform is priority number 37 on a 60-item advocacy agenda, we should not be surprised if Congress treats it the same way.
And we should stop measuring success by temporary patches
If Congress gives physicians another 2% for one year and we call it a historic victory, we reinforce the cycle.
Temporary relief may be necessary.
Take it.
But label it accurately:
a temporary rescue, not reform.
Success should mean that five years from now physicians are not organizing another emergency campaign because another temporary payment increase just expired.
What about paying for this?
This will eventually matter politically.
A permanent full inflation update costs federal money relative to current law.
Rather than pretending otherwise, physicians should participate in the discussion about financing it.
One serious candidate is site-neutral payment reform: reducing situations where Medicare pays substantially more for an outpatient service simply because the facility is hospital-owned rather than an independent physician office.
That discussion will be politically difficult because hospitals have enormous influence.
But at least it presents Congress with something more serious than:
"Please spend more money on us."
It also addresses one of the payment distortions that encourages consolidation in the first place.
The bottom line
I am not arguing that physicians should ignore the 2027 CMS rule.
Fight the immediate fight.
What I am arguing is that after decades of declining real physician reimbursement, we should stop treating each year's conversion factor as though it were a completely new crisis.
It isn't.
The recurring crisis is the result of the underlying payment structure.
And right now Congress actually has bipartisan legislation containing most of the pieces necessary to change that structure.
The question for physicians should therefore change from:
>"How do we stop the 2027 cut?"
to:
>"How do we make sure we don't have to do this again in 2028, 2029, 2030 and every year thereafter?"
Private-practice physicians should care because our practices are absorbing the damage now.
Employed physicians should care because being one layer removed from reimbursement risk does not make that risk disappear — and a world in which independent practice becomes increasingly impossible is ultimately a world in which employed physicians have fewer alternatives and less bargaining power.
The call to action is simple:
Comment to CMS on the 2027 rule before September 14.
Then contact your House member and senators about permanent structural reform.
Support H.R. 9693 — but push its inflation update toward full MEI as proposed in H.R. 6160.
Support the budget-neutrality reforms in H.R. 8163/S. 5180.
Ask your medical societies and PACs to make passage — not another temporary patch — the metric of success.
We have spent decades asking policymakers to undo the next cut.
Maybe it is time to spend our effort changing the law that keeps producing the next cut.