"ACEP is deeply disappointed by the Centers for Medicare & Medicaid Services' (CMS') decision to finalize policies in the Calendar Year 2026 Medicare Physician Fee Schedule (PFS) final rule that will harm emergency medicine, lead to more provider consolidation, and result in long-term negative impacts on patient access to care.

We share CMS' goal of ensuring that PFS valuations accurately reflect changes in resource use over time. Unfortunately, the efficiency adjustment for non-time-based services as finalized is a flawed and overly broad policy that fails to differentiate between services that can achieve further efficiencies and those that cannot, as well as those that have already been reevaluated through existing processes recently.

Additionally, halving indirect practice expense (PE) RVUs for services furnished in facilities ignores how emergency medicine is often delivered and directly strips payment intended to cover overhead that emergency physicians themselves often must bear. Most emergency physicians are not hospital employees; they staff EDs through professional services contracts and must finance their own fixed costs-24/7 physician coverage to meet EMTALA, on-call backup, clinical staffing, malpractice, billing/IT, and compliance. The finalized cut treats those costs as if the hospital absorbed them simply because care occurs in a facility, so physician payment is reduced while the physician's costs do not change. The result is straightforward: independent groups, especially smaller practices, will see shrinking reimbursement while costs remain the same-contracts become financially unsustainable, consolidation accelerates (the opposite of CMS' stated aim), and ED coverage and timely patient access to lifesaving care are put at risk.

Though we appreciate CMS' desire to ensure that health care services are appropriately valued, these policies utilize a blunt instrument when a scalpel would be more appropriate. Particularly for emergency medicine, the changes almost entirely cancel out Congress' recent actions to provide temporary relief to stabilize physician payments. ACEP welcomes the opportunity to work with CMS and Congress to reevaluate and implement critical refinements to these policies to protect physician practices and ensure access to the high-quality emergency care our patients need and deserve."