News & Media
MSMS Builds Legislative Connections; CMS Proposes Major Medicare Payment Updates
Although work on the state budget remains slow in Lansing, MSMS is still hard at work connecting with legislators. This week, Immediate Past President, Mark Komorowksi, MD, along with MSMS staff Rebecca Blake (COO) and Dara Barrera (Director of Health Quality, Equity, and Technology), participated in the annual Dutch Boy Classic golf outing fundraiser for Representative Curtis VanderWall. Representative VanderWall chairs the House Health Policy Committee. MSMS was excited to be a part of the outing and spent the day making meaningful relationships that will help impact our presence downtown.
At the federal level, CMS has released the proposed 2026 Medicare Physician Fee Schedule. Below are a few key takeaways:
- Conversion Factors: For the first time, CMS proposes four different conversion factors, based on whether a physician is a qualifying participant (QP) in an Advanced APM. The conversion factors reflect permanent and temporary updates, with QPs receiving slightly higher payments than non-QPs.
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QP: $33.5875 | Non-QP: $33.4209
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Anesthesia QP: $20.6754 | Anesthesia Non-QP: $20.5728
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- Efficiency Adjustment: A new -2.5% “efficiency adjustment” would reduce work RVUs and intra-service time for non-time-based services, affecting most surgical specialties, radiology, and pathology by roughly -1%.
- MIPS: CMS proposes to maintain the MIPS performance threshold at 75 points through the 2028 performance year to avoid harsh penalties that continue to disproportionately impact small and rural practices.
- Telehealth: CMS declined to add CPT telemedicine E/M codes to the Medicare Telehealth List.
- Practice Expense: CMS proposes redistributing indirect practice costs, leading to a -7% decrease in facility-based services and a +4% increase for non-facility-based services.
- Mandatory Payment Model: A new Ambulatory Specialty Model (ASM) is proposed for 2027 in select regions for heart failure and low back pain care, with up to ±9% payment adjustments starting in 2029.