News: CMS issues CY 2027 physician fee schedule proposed rule

CMS has issued its calendar year (CY) 2027 proposed rule for the physician fee schedule. As required by law, CMS would implement two separate conversion factors: one for qualifying alternative payment model participants (QP) and one for physicians and practitioners who are not QPs.

The rule proposed a decrease in payments to physicians by reducing the QP conversion factor by 1.19% and the non-QP conversion factor by 1.68% in CY 2027, as compared to CY 2026. These conversion factors reflect positive updates required by statute of 0.75% and 0.25%, respectively.

CMS stated the increase of 0.53% is necessary to account for proposed changes in the work relative value units. However, they are offset by the fact that the one-year statutory conversion factor increase of 2.50% for CY 2026 will not be in effect for CY 2027.

As part of broader reform efforts on the practice expense (PE) methodology, CMS proposed to reduce its reliance on specialty-specific PE per hour data. The agency also proposed changes to how it calculated indirect PE for stays in a skilled-nursing facility. In addition, it would reduce payment when a separately identifiable office/outpatient evaluation and management visit is furnished by the same physician (or physician in the same practice) on the same day as a global procedure.

CMS also proposed multiple changes to the Medicare Shared Savings Program (MSSP), which would be designed to provide additional savings in two-sided risk tracks and incentivize new accountable care organizations to participate. The proposal included several updates to the MSSP beneficiary assignment methodology.

CMS additionally proposed changes under the Quality Payment Program. These include the adoption of three new Merit-based Incentive Payment System Value Pathways (MVP), as well as the modification of all existing MVPs. These changes would remove several quality measures that no longer provide value as well as adding measures more focused on patient-recorded outcomes and chronic disease management.

The proposal also included changes to the current voluntary Medicare Part D claims data submissions to the 340B claims data repository that the agency is implementing and to make it mandatory for 340B hospitals to report this data starting in 2027.

CMS will accept comments on the proposed rule through September 14.

Editor’s note: To read the full proposal, click here. To read additional coverage from the AHA, click here.