Jesse M. Ehrenfeld, MD, MPH President | Official website
The Centers for Medicare & Medicaid Services (CMS) has announced an anticipated average payment increase of 4.33% for Medicare Advantage (MA) plans from 2025 to 2026. In contrast, physicians treating Medicare patients are facing a fifth consecutive year of payment reductions, this time by 2.8%. This occurs despite practice costs rising by 3.5%, as indicated by the Medicare Economic Index.
The disparity between the financial treatment of MA plans and physician payments has raised concerns within the medical community. "So, while MA plans receive an increase beyond the expected health care inflation rate, Congress not only failed to provide a physician payment update but allowed a new round of cuts at the end of the lame duck," a spokesperson stated. The statement further highlighted the inconsistency in providing increases to insurance companies that have experienced record profits while reducing payments to struggling physician practices.
The call for reform is underscored by warnings about potential impacts on patient access if physicians are forced to close their practices due to financial pressures. "This contrast highlights the urgent need for Congress to prioritize linking payment to physician practices to the cost of providing care," it was emphasized. As a new Congress convenes, there is a push for a reevaluation and reform of physician payment structures.
