CMS issues CY 2027 physician fee schedule proposed rule

The Centers for Medicare & Medicaid Services July 14 released its calendar year 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, or QPs, and one for physicians and practitioners who are not QPs. The rule would decrease 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, as well as an increase of 0.53% that CMS states 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 methodology, CMS proposes to reduce its reliance on specialty-specific PE per-hour data. The agency also proposes changes to how it calculates 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 a physician in the same practice) on the same day as a global procedure.

CMS also proposes multiple changes to the Medicare Shared Savings Program that would be designed to provide additional savings in two-sided risk tracks and incentivize new accountable care organizations to participate. The agency also would make several updates to the MSSP beneficiary assignment methodology.

Under the Quality Payment Program, CMS proposes to adopt three new Merit-based Incentive Payment System Value Pathways, or MVPs, and to modify all existing MVPs. These changes would include removing several quality measures that no longer provide value and adding measures more focused on patient-reported outcomes, or PRO, and chronic disease management.

CMS also proposes updates to the Ambulatory Specialty Model that was finalized last year. These updates would include clarifying quality measure scoring, excluding certain participants based on their subspecialty, adding a rural adjustment and adding a voluntary PRO data submission option.

In addition, CMS proposes to change 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 Sept. 14. AHA members will receive a Regulatory Advisory with more details.