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Getting the latest healthcare news for you
Getting the latest healthcare news for you
CMS's proposed 2027 Medicare Physician Fee Schedule takes steps to stabilize and strengthen primary care — but a built-in 1.2% conversion factor cut threatens to offset some of the progress. The rule introduces hybrid payment models, expanded behavioral health support, and a move away from AMA surveys for pricing. Primary care advocates are cautiously optimistic, but say Congress needs to act to prevent another payment cliff.
CMS has released its proposed 2027 Medicare Physician Fee Schedule, and while it includes several wins for primary care, a mandatory 1.2% reduction in the conversion factor is already casting a shadow. The qualifying APM conversion factor would drop to $33.17 (–$0.40 from 2026), and the non-APM factor to $32.84 (–$0.56), largely because a temporary 2.5% boost from the Working Families Tax Cut Act expires this year.
On the brighter side, the rule proposes expanded support for behavioral health, substance use disorders, health coaches, and shared medical appointments. CMS is also floating a hybrid payment model — blending prospective and fee-for-service payments — starting with ACOs, which advocates at the Primary Care Collaborative see as a meaningful step toward payment stability. The rule also proposes moving away from AMA surveys to determine practice expenses, favoring more empirical data sources like EHR records and claims databases.
Key Takeaways:
Why it matters: Primary care is the backbone of preventive medicine, yet it remains chronically underfunded. This proposed rule signals a policy shift toward rebalancing that — but without Congressional action on the conversion factor cut, the gains could be offset before they even begin.
