Radiologists, other docs voice concern over Medicare proposal to slash pay due to ‘efficiencies’

Radiologists and other physicians are voicing concern over a Medicare proposal to slash physician pay for services that are not tied to time. 

The federal government revealed the possible change in the 2026 physician fee schedule, released on July 14. In the past, CMS has relied on survey data provided primarily by the American Medical Association to estimate physicians’ time spent on services, along with the intensity of their work. These figures are often reflected in the valuation of codes paid under the physician fee schedule. 

However, CMS contends only a small number of codes are considered for revaluation annually. Often, these updates are influenced by “subjective information” from such surveys, which have “low response rates” with participants “who may have inherent conflicts of interest (since their responses are used in setting their payment rates).” 

The nation’s largest association of physicians bristled at this suggestion in a statement. 

“The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and healthcare professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,” AMA President Bobby Mukkamala, MD, said Friday. “This proposal would have negative repercussions for appropriately determining the resources required for effective patient care. To label practicing physicians conflicted when all they are doing is sharing their real-world patient experiences where empirical data often do not exist is biased, unfair and a skeptical opinion of community-based physicians.”

To determine this efficiency cut, CMS is proposing to use a sum of the past five years of the Medicare Economic Index productivity adjustment percentage. The agency’s Office of the Actuary calculates the MEI productivity adjustment annually. In the new physician fee schedule, CMS is suggesting a “look back period” of five years, resulting in a proposed efficiency adjustment of -2.5% for 2026. 

The American College of Radiology notes that several factors besides time go into diagnosing and treating patients. Any “perceived efficiency gains” sought by CMS have been “significantly outweighed by the substantial increase in the number of images and reconstructions performed per study,” said Gregory N. Nicola, MD, chair of the ACR Commission on Economics. 

“Cuts to provider reimbursement for so-called ‘non-time-based services’ may impact availability of imaging exams—including cancer screening tests—such as mammography and low-dose CT scans to detect lung cancer. These reductions may roll back efforts to close disparities in cancer outcomes particularly those affecting minority and rural communities where such care is less prevalent,” Nicola said in a statement. “Blacks, Hispanics and rural residents are already far more likely to die from cancer and other diseases than whites—and those in more affluent metropolitan areas. Cutting payment for these lifesaving exams is not helpful. We look forward to working with regulators and those in Congress to arrive at more sensible imaging reimbursement policies that encourage widespread access to care for all Americans.”

STAT News took a closer look at the cuts in a piece published July 16. It noted that the “efficiency adjustment” would reduce payments by 2.5% for thousands of procedures while diminishing the AMA’s impact on setting reimbursement rates. The changes are likely to benefit primary care providers, who would see the largest average pay increases, while negatively impacting rates for radiologists, pathologists, surgeons and others. The proposal exempts most time-based healthcare services, such as 30-minute visits with a PCP, while impacting most other procedures. 

“This is probably one of the most controversial components of this rule,” Shari Erickson, a top official with the American College of Physicians, told STAT. “It is sort of continuing to chip away at some of the concerns that many have raised about the [AMA Relative Value Scale Update Committee] and the power that they’re viewed as having.”

CMS contends that imaging exams and interventional radiology procedures should gain efficiencies as they become increasingly common. However, physicians believe a 2.5% across-the-board cut to these services lacks precision and nuance. Advocates also note that the physician fee schedule has failed to account for inflation since 1992, while hospitals benefit from regular automatic adjustments. 

“All medical practices every year have been doing more with perennially declining revenue per procedure,” Ned Holman, MD, an Alaska-based radiologist in private practice, told Radiology Business. “Adding an additional mechanism that targets proceduralists while sparing primary care doesn't fix the inherent problem with the MPFS. It needs an inflation adjustment factor so that pay bumps to primary care don't come at the expense of every other specialty of medicine. Otherwise, long term, we risk Medicare patients losing access to care.”