Another year of Medicare cuts, with Anders Gilberg of MGMA

CMS has released its proposed 2027 Medicare Physician Fee Schedule, and once again it carries a conversion factor cut: 1.68% for physicians outside an alternative payment model and 1.19% for those inside one, as the 2.5% congressional patch expires.
 
Physicians Practice Managing Editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, to sort out what the rule actually does. They dig into the budget neutrality rules that force CMS to cut one specialty to pay another, the agency's push to move away from the AMA's valuation process without new data to justify it, the sunset of traditional MIPS into MIPS Value Pathways and what that reporting burden means for multispecialty groups, and a sleeper change to modifier 25 that could hit same-day billing hard. 

Public comments on the proposed rule are due Sept. 14.

Music Credits:
Swinging Lounge Bar by NC MUSIC - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 Cold open: Anders Gilberg on why these are real cuts, not cuts to the growth rate

0:17 Introduction

1:39 Keith Reynolds welcomes Anders Gilberg

2:11 The recurring themes in the proposed 2027 fee schedule

3:56 Five years of cuts, and what MGMA members are feeling

5:38 Congress's game of chicken and the new Patients First Act

6:58 Budget neutrality and robbing Peter to pay Paul

8:09 CMS's 20-year-old cost data and the move away from the AMA process

10:34 The end of traditional MIPS, and why MVPs are "MIPS on steroids"

13:20 P2 Management Minute

14:35 What small and rural practices should do now

16:13 The sleeper provision: modifier 25 and same-day billing

18:13 Comments are due Sept. 14, but will CMS budge?

20:20 The next fiscal cliff and the year-end lame duck session

22:29 Outro