Public comments on Medicare's proposed 2027 physician fee schedule closed Sept. 14 with a provision on the table that would pay 50% for one of two services when a patient gets an office visit and a procedure on the same day.

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), joins Physicians Practice Managing Editor Keith Reynolds to explain what that would look like in the exam room, why budget neutrality rules keep pitting specialties against one another and what the bipartisan Patients First Act would change.

They also cover the mandatory Ambulatory Specialty Model that starts Jan. 1 with its participant list still unpublished, what else is sitting in the lame-duck pile and the AI policies Gilberg says every practice should have in writing. The final 2027 fee schedule is expected on or about Nov. 1.

Music Credits:
Cozy Evening Coffee Time by BJBeats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:23 | Cold open Anders Gilberg on patients being asked to come back the next day for a procedure.

0:23 – 1:29 | Introduction Austin Littrell previews the episode and MGMA's centennial Annual Conference in San Antonio, Sept. 27-30.

1:29 – 1:59 | Meet Anders Gilberg Keith Reynolds welcomes Gilberg back on the day public comments closed on the proposed 2027 fee schedule.

1:59 – 4:41 | The one change MGMA wants Another conversion factor cut is in the rule, but Gilberg says the change CMS can make on its own is dropping a proposal to pay half for one of two services billed the same day. He walks through a dermatology example and the Same Day Care Coalition's opposition.

4:41 – 5:56 | The Patients First Act The bipartisan doctors caucus bill would tie annual fee schedule updates to the Medicare Economic Index, rework budget neutrality and reform quality reporting.

5:56 – 8:06 | Why CMS can't fix budget neutrality alone The $20 million trigger is written into law. Gilberg points to a 2024 add-on code whose use was overestimated by roughly $1 billion, a cut physicians never got back.

8:06 – 9:19 | The quiet part: practice expense Practice expense values cover overhead, and Gilberg explains why keeping the lights on, paying staff and buying supplies makes this an administrator's issue.

9:19 – 11:10 | The Ambulatory Specialty Model starts Jan. 1 Gilberg says practices aren't ready because the participant list still hasn't been published, and notification is expected to run through a portal each physician checks individually.

11:10 – 12:13 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to send in their own, then turns to the lame-duck session.

12:13 – 13:45 | Will Congress fix the cut? Gilberg on why modest cuts are harder to fight than big ones, drawing on his experience with the SGR years.

13:45 – 15:38 | What else is in the lame-duck pile The work geographic price index floor and the expiring alternative payment model incentive bonus, plus why a retroactive fix in the new year is the outcome nobody wants.

15:38 – 18:51 | AI guardrails inside the practice Governance, written policies on what gets typed into tools like ChatGPT, HIPAA and malpractice exposure under laws already on the books, and keeping the human element in the physician-patient relationship.

18:51 – 19:39 | What to watch next The final rule is expected on or about Nov. 1, and Gilberg says practices won't know until the 11th hour whether the same-day cut survived.

19:39 – 20:36 | San Antonio Keith and Gilberg on the MGMA Annual Conference.

20:36 – end | Outro

S1 Ep187: Medicare's plan to pay half for same-day care, with Anders Gilberg of MGMA

Off the Chart: A Business of Medicine Podcast

S1 Ep187: Medicare's plan to pay half for same-day care, with Anders Gilberg of MGMA