MGMA’s Anders Gilberg on what the latest funding scramble meant for practices

On Jan. 22, with another federal funding deadline just days away, physician practices were still bracing for the kind of policy whiplash that can disrupt care and complicate billing. Now that Congress has cleared the year’s funding package and avoided another shutdown showdown, practices can plan with more certainty. In this Physicians Practice interview, Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, breaks down what the deal locks in for telehealth, rural payment protections, and lab reimbursement, and what questions remain as 2026 unfolds.

The following transcript has been edited for clarity and length.

Physicians Practice: Let’s get right into it. Anders, when Washington punts on funding at the last minute, what’s the first thing that breaks down for medical groups: staffing, cash flow, or patient access?

Anders Gilberg: I think you’re referring to the aftermath of the government shutdown in the fall, and we’re up against another deadline soon.

Physicians Practice: Jan. 30, right?

AG: That’s right. And what happened then, I don’t think we’ll have the same issues this time. I don’t think the government is going to shut down. But it was a real problem.

Medical groups and physician practices have been dealing with this for a while, especially since the end of 2024, when a lot of things important to them, like the ability to provide telehealth or move into an alternative payment model, got delayed. These are what we call health care extenders.

In the fall, we had a situation where telehealth flexibilities in Medicare basically expired, the policies that allow physician practices to provide telehealth in Medicare at all. And while the government was shut down, they were reinstated, but it caused real problems for practices trying to maintain continuity of care.

A lot of telehealth appointments were canceled. Practices had to bring patients in physically, which created issues around transportation, reimbursement, and everything that comes with changing workflows on the fly.

That’s the disruptive part: practices have to change midstream, only to then have Congress reinstate policies a few weeks later. Telehealth is one example. There were others. But when Congress can’t agree, or delays implementation, practices feel it immediately.

Physicians Practice: You mentioned telehealth extensions. They’ve extended it a couple times. If they keep extending it but don’t make it permanent, is that really progress, or are practices stuck in limbo?

AG: There’s been some concern with telehealth. It took off during COVID, and I think everyone acknowledges it’s beneficial for beneficiaries. That’s not really the debate anymore.

The apprehension has been: Would it increase fraud? Could it introduce more fraud into the system? Could it drive up volume, Medicare patients getting excessive amounts of care? Would it cost the system more?

But a lot of those concerns haven’t borne out. And because of that, there’s more appetite now to extend it.

At the end of this month, there’s an appropriations bill being considered by the House and Senate over the next week or so. What’s notable is it doesn’t just do a short-term patch. It would extend telehealth through 2027, which is a lot better than what we’ve been seeing, where Congress kicks the can for three or four months at a time and then you’re right back in the same uncertainty.

So that’s a positive sign that Congress is starting to think longer-term. But we have to make sure the bill passes, and it needs to be enacted by the end of the month to keep the government running.

Physicians Practice: Staying on telehealth, if you were “God Emperor Anders” of the U.S., what rules would you lock in permanently, and why?

AG: Before COVID, Medicare telehealth coverage outside of rural areas was extremely limited. A lot of people don’t even remember that, but it wasn’t broadly covered.

And even in rural areas, if a patient needed telehealth, say they needed to connect with a specialist in another city, maybe a subspecialist for a rare disease, they still had to go to an originating site. It had to be a HIPAA-secured location, so they’d literally have to go into a physician’s office or another approved site just to have a telehealth visit with another physician.

So there are two big changes that the flexibilities introduced.

One: basic coverage outside rural areas. That’s critical, because so much of the country isn’t rural, and patients everywhere benefit from this.

Two: allowing the patient to receive care in their home rather than requiring an originating site. If the flexibilities are extended, rural patients in particular won’t be forced into that extra step, and patients everywhere get more realistic access to telehealth.

Those are the two big ones I would lock in.

Physicians Practice: All right, switching gears. MGMA has pushed for the 1.0 work GPCI floor. In plain terms, what happens to rural practices if Congress doesn’t adopt that?

AG: For years, Congress has been averting what’s called the lapse of the 1.0 floor on the work GPCI.

In simple terms, Medicare uses a geographic adjustment to determine how physician work is valued in different areas. The baseline is 1.0. Some localities are below 1.0 and some are above it. Downtown Los Angeles, for example, would be above 1.0.

But in rural areas, if that 1.0 floor lapses, physician work can be valued below the baseline. That becomes a dollars-and-cents issue. Yes, it might be slightly less expensive to provide care in some rural settings, but rural physicians also face unique costs that don’t make their work less valuable. Their training is the same. Their expertise is the same.

Congress has routinely stepped in to prevent the lapse because access in rural areas depends on keeping those practices financially viable.

The problem is when it’s handled through short-term fixes. Last year, it was limping along under continuing resolutions. It expired at the end of September, rural physicians were paid less, and then a lot of claims had to be rebilled. That becomes an administrative headache on top of everything else.

We’re pleased Congress is at least looking a bit longer-term this time, but our view is: let’s permanently fix it.

Physicians Practice: For practices with in-office labs, what do the next PAMA-related cuts mean in real life? Are we talking fewer tests, longer turnaround, or sending patients out of house?

AG: PAMA is the law that changed how lab services are valued, not just in physician offices but across the lab market, including large reference labs.

For physician practices, the goal is to provide a full range of services for patients. If an older patient needs lab work, you want to be able to do it without sending them home, having them arrange transportation, and then either come back or go somewhere else.

At the end of the month, there are cuts scheduled because of how certain lab tests were valued based on data Medicare collected. Those cuts could be around 15% for practices with physician-owned labs.

Reimbursement is already relatively low for lab services, and practices don’t have the economies of scale that big reference labs do. They’re not running thousands and thousands of tests. So a 15% cut hits hard.

What’s on the table at the end of the month is delaying the cuts, and that’s important. But there’s also the RESULTS Act, which we support, that would address the underlying problem by reforming the data collection methodology that led to the cuts in the first place. That deeper reform is what we ultimately need.

Physicians Practice: And MGMA sent a letter to Congress earlier this month on that, right?

AG: Right. And one encouraging sign is the Energy and Commerce Committee was looking at a number of health care bills, and that was one of them. So we’re hopeful there’s movement.

Physicians Practice: MGMA is also pushing Congress to restore advanced APM incentives and ease QP thresholds. Are groups actually leaving value-based care models because the math isn’t working anymore?

AG: The hard part for practices is the transition. Fee-for-service pays you for everything you do. Value-based care often pushes you toward higher quality and sometimes lower volume, doing less, but doing it better.

Those incentives can clash during the transition. Practices often need a cushion, some subsidy, to move into advanced alternative payment models under Medicare without taking an immediate hit to revenue.

That’s what the APM incentive payments have helped with. People call them bonuses, but it’s really additional money tied to your fee-for-service Medicare billings that helps support the move toward value-based care while you’re building the model, before shared savings or other downstream payments kick in.

We didn’t have that for practices in 2025, because the legislation at the end of 2024 didn’t pass. The funding bill at the end of this month would reinstate it at about 3.1%. That’s meaningful for practices that want to move into value-based care but can’t absorb the upfront financial shock.

Physicians Practice: Another big issue tied to last year’s shutdown mess: ACA subsidies. Those expired earlier this year. What does that look like on the ground for practices, cancellations, bad debt, uncompensated care?

AG: We’re in January, so it’s still early to measure the full fallout. But for practices whose payer mix includes exchange coverage, if patients can’t renew because premiums doubled or tripled without the premium tax credits, practices have to adapt quickly.

That can mean payment plans, discounts for cash-pay arrangements, and other accommodations, but practices also have to protect their bottom line.

It also raises the risk that patients skip primary care visits, and problems that were manageable become acute, and then they end up in the hospital. These kinds of coverage shocks aren’t good for the health care system.

And practices have to get much more aggressive about eligibility verification, even for existing patients, because coverage can change or lapse at year-end.

It’s a problem, but it’s also part of a larger picture. If you combine that with Medicaid changes projected closer to 2027, including state work requirements, the impact could be much larger, with projections of more than 10 million people becoming uninsured. So the combination is what concerns us.

I’m happy to come back and talk more as practices get further into the year and we have clearer data on what they’re seeing.

Physicians Practice: Switching gears a bit. The One Big Beautiful Bill Act gave more flexibility for using HSA dollars to pay for DPC or concierge care. Is that a sign Congress is shifting preference toward these models over the traditional independent practice?

AG: They need to be careful. Not every patient can be in direct primary care. Some MGMA members operate in those arrangements, but generally patients need resources to do that. And often the patients with the most chronic conditions and the most needs are not the ones in those models.

The administration has been signaling, through its technology policies and value-based care direction, including the work coming out of the Center for Medicare and Medicaid Innovation, that it wants more consumer-directed care. So this aligns with that.

But it’s not clear yet how much this will change things at scale. For patients on Medicare or Medicaid with multiple chronic conditions, their care needs are heavy. Primary care is critical, but they also need coverage that supports hospitalization, acute care, and the rest of the system around them. That’s the key question: how these models fit into a broader coverage framework.

Physicians Practice: Last one. You guys always have your fingers in a ton of pies. What should practice leaders be watching from MGMA this year?

AG: At the start of each year, MGMA government affairs puts out our advocacy agenda. It’s not dramatically different than prior years, but we’ve adapted it to what we’re seeing with this administration. We try to be proactive in Washington, but we also have to react to what’s coming down the pike, especially on the regulatory side.

One issue we’re watching is cybersecurity. This administration keeps talking about a binary rule related to cybersecurity, and our concern is an unfunded mandate, potentially requiring medical groups to spend extremely high dollars if they finalize what was proposed under the Biden administration.

So stay tuned. There’s a lot happening in health care, a lot of technology programs moving forward, and HHS has shown itself to be very independent in its thinking and in many ways controversial. We’re there to support medical practices, and we appreciate the opportunity to chat. I think it’s going to be an interesting year in 2026.