Medicare cuts, telehealth limits loom

Medicare cuts, mounting administrative burden and looming policy expirations are at the top of the advocacy agenda for the Medical Group Management Association, said Anders Gilberg, senior vice president of government affairs, during the MGMA Leaders Conference 2025.

Gilberg said MGMA secured a 2.5% payment increase for physicians through the “One Big Beautiful Bill Act,” but warned that new proposals in the 2026 Medicare Physician Fee Schedule could shift reimbursement away from specialty and procedure-driven codes. “Even though there’s an increase in the conversion factor for Medicare, some specialists could see cuts if those rules are finalized,” he said.

Medicare payment challenges ahead

Medicare’s reimbursement model is becoming more complex, Gilberg said, with potential reductions for procedure-heavy specialties. MGMA has pushed back, calling the proposed changes “arbitrary” and not grounded in data.

Administrative burden persists

Administrative complexity remains MGMA’s top issue, especially around prior authorization. Gilberg noted that earlier deregulatory efforts such as “Patients Over Paperwork” have stalled. “This administration has been more chaotic … they haven’t really focused on very specific initiatives to reduce the paperwork burden,” he said.

Despite setbacks, Gilberg pointed to progress. Regulations targeting prior authorization in Medicare Advantage and Medicaid are finalized and set for implementation next year. “I’m really proud of that advocacy,” he said, while cautioning that broader legislative fixes remain stalled in Congress.

Telehealth flexibilities at risk

With the government two days away from a potential shutdown, Gilberg said key provisions are at risk. Telehealth flexibilities adopted during the COVID-19 pandemic could expire, reverting to pre-pandemic rules that restricted access to rural patients at originating sites.

Rural practices face payment threats

Also on the line are rural payment protections known as the geographic practice cost index floor. “If that expires, their payments will be significantly impacted negatively,” Gilberg said.

How practice leaders can influence lawmakers

Gilberg encouraged practice leaders to strengthen relationships with lawmakers by inviting them to visit practices. MGMA also offers a grassroots center where members can generate tailored letters to Congress. “Oftentimes it’s just the good old relationships back in the district that really do the trick,” he said.

Preparing for ACA subsidy expiration

Looking ahead, Gilberg said practices should prepare for uncertainty around ACA premium subsidies, which expire at the end of 2025. Without renewal, as many as 4 million people could lose coverage. “That would increase the burden on practices … and hopefully not deter patients from getting preventive care,” he said.

Medicaid coverage also faces long-term risks, with provisions in recent legislation potentially affecting up to 10 million beneficiaries in 2027.

What’s next in Washington

Gilberg urged practice leaders to stay engaged as Congress weighs these issues. “Within the next couple of days, we’re going to really see fireworks in Washington,” he said.