Another year of Medicare cuts, with Anders Gilberg of MGMA

CMS's proposed 2027 Medicare Physician Fee Schedule carries another conversion factor cut: 1.68% for physicians outside an alternative payment model and 1.19% for those inside one. It is the fifth straight year the rate has been under threat, and for independent practices paid almost entirely under the fee schedule, the math is getting harder to absorb.

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, has spent those years pressing Congress and CMS to overhaul the way Medicare pays physicians. The proposed rule, released in July, reaches well beyond the conversion factor, from the budget neutrality requirements that force cuts in one specialty to fund another to the phaseout of traditional MIPS.

Gilberg sat down with Physicians Practice Managing Editor Keith Reynolds to break down what the rule actually does, from the budget neutrality shifts that move payment between specialties to the reporting burden replacing MIPS and a proposed change to modifier 25 that could hit same-day billing. CMS is accepting public comments on the proposed rule through Sept. 14.

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

0:00 – 0:17 | Cold open Gilberg on why these are real cuts, not cuts to the growth rate.

0:17 – 1:39 | Introduction Austin Littrell introduces the episode, the guest and the proposed rule's headline conversion factor cut.

1:39 – 3:56 | The themes in the proposed rule Gilberg's overview: another conversion factor cut, a tilt toward value-based care and the budget neutrality rules driving specialty-by-specialty shifts.

3:56 – 5:38 | Five years of cuts After repeated last-minute patches, Gilberg describes the pressure on independent practices and the pull toward consolidation.

5:38 – 6:58 | Congress's game of chicken The 2.5% patch expires Dec. 31. Gilberg on the newly introduced Patients First Act and why the real fix is legislative.

6:58 – 8:09 | Budget neutrality and robbing Peter to pay Paul Why the rule highlights the problem rather than fixing it, and which specialties stand to get hurt.

8:09 – 10:34 | CMS's 20-year-old data and the AMA process Gilberg on the agency wanting to move away from the AMA's valuation process without new data to justify it.

10:34 – 13:29 | The end of MIPS Why the shift to MIPS Value Pathways is "MIPS on steroids," and the reform bill MGMA backs instead.

13:29 – 14:35 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to submit their own workflow ideas.

14:35 – 16:13 | What small and rural practices face The cumulative administrative burden of the rule's moving pieces, and its failure to ease it.

16:13 – 18:13 | The sleeper provision A proposed change to modifier 25 that could cut payment when an office visit and a procedure fall on the same day.

18:13 – 20:20 | Will CMS actually budge? Comments are due Sept. 14, but Gilberg has seen little movement between proposed and final rules under this administration.

20:20 – 22:06 | The next fiscal cliff Gilberg on whether Congress averts the cut, the year-end extenders and the lame-duck session ahead.

22:06 – 23:52 | Closing thoughts and outro Reynolds wraps with Gilberg, and Littrell closes the episode.