Doctors could see 3.8% Medicare pay bump in 2026

• But a provision from a decade-old Medicare law that kicks in next year may help them get a pay boost for 2026.

State of play: Physician practices that agree to be paid based on patient outcomes are in line for a 3.8% pay bump next year, while doctors who don't participate in a qualifying alternative payment model would get a 3.3% increase.

• The figures include a 2.5% one-year increase Congress passed this month as part of its massive tax and spending bill.

The administration also wants to change how it calculates Medicare payment for many medical billing codes, and move away from relying on survey data collected by the American Medical Association's Relative Value Scale Update Committee.

• The Centers for Medicare and Medicaid Services proposes adjusting payment for billing codes using a figure calculated by Medicare actuaries that incorporates the past five years of medical practice cost inflation.
• In all, the adjustment would decrease payment for codes that aren't based on physicians' time by 2.5% in 2026, CMS says.
• "CMS expects that moving away from survey data would lead to more accurate valuation of services over time and help address some of the distortions that have occurred in the [payment program] historically," the agency said in a fact sheet.
• Several policymakers, academics and other policy experts have over the years advocated for reducing the AMA's influence in Medicare rate setting.

Between the lines: The change would likely translate to increased pay for specialties like family medicine, geriatrics and psychiatry, which more often bill for timed codes, CMS writes in the proposed rule.

• Specialties that more often bill for procedures, like radiation oncology and radiology, would likely see decreased payment for their codes.

What they're saying: "After an initial review, we are encouraged CMS aims to tackle many of the core reasons Medicare — and the broader health system — has consistently underinvested in primary care and prevention," Ann Greiner, CEO of the Primary Care Collaborative, said in a statement.

• But doctors are still calling for Congress to revamp their Medicare payment system.
• "Health systems and medical groups continue to bear the brunt of an outdated and underfunded reimbursement model," American Medical Group Association President Jerry Penso said in a statement Monday. "Without systematic reform, Medicare's current fee-for-service framework will remain misaligned with the shift toward high-value care."

Zoom out: The 1,803-page administration proposal laid out several other changes to providers' Medicare payment, including altering the way the program pays for skin substitutes to help heal wounds, which have been a recent target for fraud investigations.

• The administration also plans to launch a mandatory payment experiment for specialists who often treat Medicare patients with low back pain or heart failure in outpatient settings.
• The experiment would financially reward doctors for improving upstream chronic disease management, CMS said.
• Comments on the rule are due Sept. 12.