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Commentary|Podcasts|October 29, 2026
Medicare's 2027 fee schedule won't settle the physician pay debate, with four health policy experts
Author(s)Austin Littrell
Fact checked by: Keith A. Reynolds
Four health policy experts preview the proposed 2027 Medicare physician fee schedule and what the same-day visit cut, prior authorization and alternative payment models mean for practices.
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One physician Miranda Yaver, Ph.D., interviewed had five staff members dedicated to prior authorization and insurance administration, costing about a third of a million dollars in salary alone, she says.
Yaver, an assistant professor at the University of Pittsburgh, is one of four health policy experts guest interviewer Cameron J. Sabet, M.S., MBA, M.A., a medical student at Georgetown University, sat down with separately ahead of the final 2027 Medicare physician fee schedule.
The others are Michael Chernew, Ph.D., of Harvard Medical School; Jonathan Ketcham, Ph.D., of Arizona State University; and David O. Meltzer, M.D., Ph.D., of the University of Chicago.
Medical Economics Senior Editor Richard Payerchin connects the interviews.
The experts cover how a proposed cut to visits billed on the same day as a procedure could push practices to split appointments, why Ketcham says the fee schedule keeps rewarding larger organizations and why Chernew encourages small practices struggling with alternative payment models to join conveners that help them succeed while keeping control of the practice.
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Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:57 | Cold open Ketcham, Chernew, Yaver and Meltzer on payment rates, fairness, rationing and hybrid payment models.
0:57 – 2:22 | Introduction Austin Littrell introduces the episode and the experts and previews the Physicians Practice Practice Academy on Oct. 29.
2:22 – 3:26 | Is it really a cut? Chernew says the 2027 conversion factor drop is the same as it would have been under current law once a temporary increase expired.
3:26 – 5:18 | 35% below 2016 Ketcham says real Medicare rates have fallen sharply since 2016, commercial rates have tracked along and the result has pushed physicians toward consolidation.
5:18 – 7:36 | When pay cuts become an access problem Yaver notes 98% of non-pediatric physicians accept traditional Medicare, and Chernew explains why the Medicare Payment Advisory Commission found access adequate but still recommended paying more.
7:36 – 9:00 | The same-day visit cut Yaver says a proposed cut to visits billed on the same day as a procedure could spread care across more appointments for older patients.
9:00 – 12:06 | Is Medicare paying for the wrong things? Meltzer on risk selection, the limits of pay for performance and how advanced primary care management fees helped his program's primary care break even.
12:06 – 12:58 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
12:58 – 14:39 | Fairness vs. economics Chernew argues physician pay comes down to what it costs to get the services we want, not what feels fair.
14:39 – 15:57 | Does the fee schedule favor bigger practices? Ketcham says administrative and legal barriers, not medicine itself, push practices to grow, and the 2027 changes continue that momentum.
15:57 – 17:31 | Paying for prior authorization work Yaver on the Wasteful and Inappropriate Service Reduction (WISeR) Model pilot, nearly 53 million Medicare Advantage prior authorization requests in 2024 and one practice's five-person prior authorization staff.
17:31 – 18:23 | Sunset the fee schedule Ketcham, back in academia after working in the White House, says he would get the government out of setting physician prices.
18:23 – 19:42 | Do alternative payment models work? Chernew says they only have to be better than fee-for-service and urges small practices to look at conveners.
19:42 – 20:56 | A fixed payment per patient? Meltzer warns flat per-patient payments invite avoiding sicker patients and says hybrid models matter.
20:56 – 22:37 | The most important change Yaver warns that well-intentioned policies, like prior authorization, can backfire and make care costlier.
22:37 – End | Outro Littrell thanks the experts and wraps the episode.
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