https://www.nytimes.com/2025/07/21/upshot/primary-care-doctors-salaries.html
An Attack on the Medical Establishment Buried in an 1,800-Page Regulation
If approved, a new rule could end the entrenched pay advantages for specialists like surgeons over other doctors.
By Reed Abelson and Margot Sanger-Katz, The New York Times, July 21, 2025
For decades, the prices Medicare pays doctors for different medical services have been largely decided not by Medicare itself, but by a powerful industry group, the American Medical Association.
An A.M.A. committee meets in secret to determine the difficulty and time demands of each type of medical visit, test and procedure, and then recommends to Medicare how much doctors should be paid for performing them…
But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors…
Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in “efficiency” over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years…
The effort to adjust what doctors are paid for their work is just one part of the large rule, which also contains provisions to broaden coverage for telemedicine, pay for more mental health care, and reduce overpayments for a new and expensive type of skin bandage…
That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere…
The proposal isn’t yet a final policy. Interested parties will have 60 days to offer comments, and regulators will make their final decisions in October. If it is finalized, it will start affecting Medicare payments in January 2026. … [end quote]
This rule will have an impact on patients all over the country. Specialists may refuse to treat Medicare patients.
The rule about services on a hospital campus is problematic for rural hospitals which charge a “facility fee.” Removing the facility fee will chip away at the finances of rural hospitals which are already operating at a loss. Our rural county may lose its only hospital and there are hundreds more across the vast spaces of rural America.
Wendy