Big Five Coalition Urges CMS Administrator to Withdraw Dangerous Medicare Payment Proposal

In a recent letter to Dr. Mehmet Oz, Administrator for the Centers for Medicare & Medicaid Services (CMS) the elected leadership of the medical societies of California, Texas, New York, Florida, and Pennsylvania, known as the Big Five Coalition, expressed strong opposition to the proposed CY 2027 reduction in the Medicare physician conversion factor and urged the proposal be dropped. Together, the five states represented by the coalition are home to more practicing physicians than any others in the country: over 400,000 physicians, nearly 40 percent of the entire U.S. physician workforce.

This proposal is the continuation of a policy failure that has been in effect for over three decades. Considering inflation, Medicare physician payment has collapsed 53 percent since the advent of the Resource-Based Relative Value Scale (RBRVS) in 1992, a decline without parallel anywhere else in American medicine, and one that no other sector of the economy would tolerate for a single year, let alone thirty. Physicians are still the only participant in the Medicare program with no statutory mechanism to keep pace with inflation. Hospitals, skilled nursing facilities, and Medicare Advantage plans all receive built-in, predictable updates. Physicians do not, but are expected to treat more patients, absorb higher practice costs, and put patient access at risk.

The group is urging CMS to do the following:

1. Withdraw the proposed CY 2027 conversion factor reduction and replace it with a positive update reflecting the Medicare Economic Index.
2. Establish a permanent, statutory link between the physician conversion factor and the Medicare Economic Index, ending the annual cycle of cuts and temporary congressional patches.
3. Eliminate the site-of-service payment differential, which pays more for identical care simply because it is billed by a hospital-owned outpatient department rather than a physician's office. The Congressional Budget Office estimates that expanding site-neutral payment across hospital outpatient departments, imaging, and drug administration would save Medicare more than 170 billion dollars over ten years, with no reduction in the care beneficiaries receive. This is a proven, scored source of federal savings that does not require cutting physician payment to achieve.

To send a letter to your member of Congress about this critical issue, go to MSSNY's Grassroots Action Center (GAC). MSSNY will continue to monitor this critical issue and share updates as they develop.