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Doc Groups Say Proposed Medicare Payment Increase Is Inadequate

UNITED STATES, JUL 15 – CMS proposes a 3.62% increase in physician payments and introduces a new Ambulatory Specialty Model to improve care quality and reduce Medicare spending waste, saving $280 million.

  • The U.S. federal agency overseeing Medicare and Medicaid programs has proposed the 2026 Medicare Physician Fee Schedule, which includes introducing a new Ambulatory Specialty Model aimed at enhancing heart failure care starting in January 2027.
  • The proposal addresses the dramatic rise in Medicare expenses for skin substitutes, which grew from a few hundred million dollars in 2019 to several billion dollars by 2024, a surge largely attributed to exploitative pricing strategies.
  • The rule proposes different payment rates based on whether clinicians participate in designated alternative payment models, seeks to minimize wasteful spending, enhances chronic disease management, and updates quality measurement criteria.
  • The qualifying APM conversion factor will increase by $1.24 to $33.59 and the nonqualifying by $1.17 to $33.42, reflecting a 2.5% base rate hike mandated by recent budget legislation.
  • Physician groups welcomed the modest payment increase but criticized it as underwhelming amid years of underpayment that threaten patient access and private practice sustainability.
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hitconsultant.net broke the news in on Monday, July 14, 2025.
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