MGMA urges Congress to overhaul Medicare physician payment, scrap MIPS 'tournament' scoring

The Medical Group Management Association (MGMA) is pressing Congress to enact structural reforms to Medicare physician payment, telling House lawmakers that the current reimbursement system has "long threatened the livelihood" of medical practices and that the Quality Payment Program's reporting demands have grown unsustainable for the group practices the association represents.

In a statement for the record submitted to the House Energy and Commerce Subcommittee on Health for its May 20 hearing on the Medicare Physician Fee Schedule and MACRA, MGMA Senior Vice President of Government Affairs Anders Gilberg called for comprehensive reform to address inflation-lagging payment updates, budget neutrality cuts and the administrative weight of the Merit-based Incentive Payment System.

"Congress must intervene to create long-term stabilization for the Medicare reimbursement system that has long threatened the livelihood of our nation's medical practices," Gilberg wrote on behalf of MGMA's roughly 60,000 medical practice administrators and 15,000 group practices, representing more than 350,000 physicians.

The hearing, part of the committee's ongoing Affordability Series, is examining the 2015 law's structural impact on physician payment and reporting more than a decade after enactment.

MGMA's letter backed three specific pieces of legislation.

The Strengthening Medicare for Patients and Providers Act (H.R. 6160) would tie annual physician payment updates to inflation as measured by the Medicare Economic Index. MGMA argues such an inflationary update is necessary to align Medicare's physician payments with other CMS payment systems and to adequately account for the cost of operating a medical group.

The Provider Reimbursement Stability Act (H.R. 8163) would raise the long-static $20 million budget neutrality threshold to $54.3 million and index it to inflation. The current threshold has been in place since the 1990s and triggers across-the-board cuts when relative value unit changes exceed it, a structure that critics say pits specialties against one another. The bill would also allow for the correction of erroneous utilization estimates that have resulted in unwarranted cuts in past years.

Gilberg noted that physician practices absorbed a 2.83% cut to the Medicare conversion factor for all of 2025. While Congress passed a 2.5% increase for 2026, MGMA said the new rates are "barely above 2024 reimbursement levels" and that downstream CMS policy changes have further reduced reimbursement for certain specialties.

The MIPS critique anchors the second half of the letter.

Citing a 2021 JAMA Health Forum study, Gilberg said practices spend an average of $12,811 per physician on MIPS compliance, with clinicians and administrators putting in more than 200 hours per physician on reporting activities.

In MGMA's 2026 Regulatory Burden Report, 86% of members surveyed who participate in MIPS said reporting had increased administrative burden with little clinical benefit. One member, quoted in the letter, called the program "especially unworkable."

MGMA's complaints with MIPS extend beyond the time costs. The association said clinicians are required to report on quality measures that are not clinically relevant to their practices and that CMS does not provide timely or actionable feedback to allow improvement during the performance year. Steep payment cuts often result from what Gilberg described as "opaque scoring methodologies and the punitive tournament-style model."

To address those concerns, the association is backing the Medicare Physician Data-driven Performance Payment System Act (H.R. 8622), introduced by Rep. Mariannette Miller-Meeks (R-Iowa) in April 2026.

The bill would replace MIPS with a new Data-driven Performance Payment System effective January 1, 2027, eliminate the tournament-style scoring approach, tie payment adjustments to annual updates, freeze the current performance threshold, and require CMS to provide timely feedback reports and claims data during the performance year.

Why did MGMA thank Congress?

MGMA thanked Congress for reinstating the Advanced Alternative Payment Model incentive payment at 3.1% for the 2026 performance year through the Continuing Appropriations Act, 2026, and for reverting the qualifying APM participant thresholds to 2024 levels. The incentive lapsed in 2025, which MGMA said contributed to financial instability for practices and delayed investments in value-based care infrastructure.

The letter urged Congress to make those policies more durable and pressed for a renewed commitment from the CMS Innovation Center (CMMI) to physician-developed payment models.

MGMA noted that CMMI has yet to adopt any models recommended by the Physician-Focused Payment Model Technical Advisory Committee, even as the agency has launched newer models like the Wasteful and Inappropriate Service Reduction (WISeR) and Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) demonstrations, which target technology companies rather than physicians as primary participants.

The association also urged CMMI to keep models voluntary, arguing that forcing untested mandatory participation creates unnecessary financial and administrative burdens on practices that are not in a position to absorb them.

The Primary Care Collaborative submitted a statement for the record.

MGMA is not alone in submitting a statement for the record. The Primary Care Collaborative (PCC), in a parallel filing from President and CEO Ann Greiner, called for Congress to update the budget neutrality threshold to reflect inflation and pressed for hybrid payment models that combine up-front payments with fee-for-service reimbursement for selected services.

PCC noted that primary care accounts for less than 5% of all health spending, and just 3.7% of Medicare spending, despite handling roughly half of all office visits. Greiner cited Milbank Memorial Fund data showing about 30% of Americans don't have a continuous relationship with a primary care clinician they trust.

Related content: The primary care crisis, by the numbers, with experts from the Milbank Memorial Fund, the Physicians Foundation and the Robert Graham Center

PCC's letter also backed simpler MIPS measures and reduced reporting requirements for clinicians participating in APMs or adopting Advanced Primary Care Management codes.

What comes next

In his opening statement, subcommittee Chairman Morgan Griffith (R-Virginia), acknowledged the persistent issues raised by group practice administrators, saying shifting quality measures and administrative burdens have "slowed adoption of MACRA's quality payment programs" and led to additional complexity and costs that are "especially concerning for smaller, independent, and rural providers."

Griffith also noted that the current temporary payment bump is set to expire at the end of the year, leaving the underlying long-term reimbursement structure unresolved going into 2027.

Witnesses scheduled to testify include William Fox, M.D., MACP, chair emeritus of the American College of Physicians Board of Regents; Steven Furr, M.D., FAAFP, a family medicine physician; Dana Smetherman, M.D., M.P.H., MBA, FACR, CEO of the American College of Radiology; Rick Snyder, M.D., president of HeartPlace; and Farzad Mostashari, M.D., CEO and co-founder of Aledade.