AMA coalition presses Congress to blunt 2027 Medicare physician pay cuts
The American Medical Association and 61 other healthcare organizations are pushing Congress to fold four Medicare payment reforms into any year-end legislative package, arguing that physician payment pressure is now threatening patient access as well as practice stability. The coalition’s message comes just after CMS finalized the 2027 Medicare Physician Fee Schedule, which cuts the conversion factor for most physicians by 2.31% on Jan. 1. Most of that reduction traces back to the expiration of a one-year 2.5% increase Congress provided for 2026.
The policy fight is not abstract. Medicare physician payment has fallen about 33% since 2001 when adjusted for inflation in practice costs, a long slide that has eroded the real value of work performed in clinics, exam rooms, and procedure suites. When payment lags behind the cost of delivering care, physicians absorb the difference through thinner margins, fewer staff, and tighter appointment capacity. In specialties that already run on narrow operating margins, the effect can quickly translate into longer waits and reduced Medicare participation.
Willie Underwood III, MD, MSc, MPH, president of the AMA, called the requested changes “practical, bipartisan steps Congress can take now.” That framing reflects how the coalition is trying to position the issue: not as a sweeping overhaul, but as an immediate buffer against further destabilization while lawmakers work toward a more durable payment structure.
Four asks aimed at payment stability and same-day care
The coalition wants Congress to extend the 2.5% update through 2027 and pass the bipartisan Provider Reimbursement Stability Act. It also wants a one-year delay of the new same-day visit reduction, a policy that still penalizes same-day care even after CMS scaled it back. The fourth request is a 2% cap on penalties under the Merit-based Incentive Payment System, or MIPS, a program physicians have long criticized for consuming large amounts of administrative time for very little upside.
Each request addresses a different pressure point in Medicare’s payment machinery. The conversion factor sets the basic dollar translation for physician work, so any cut hits broadly across the system. The same-day visit policy matters because patients often arrive with more than one issue, and compressing multiple services into one encounter can be clinically appropriate, especially for older adults with complex chronic disease. A payment policy that discourages same-day care can force avoidable return visits, add travel burden, and slow access for patients who already face logistical barriers.
The MIPS proposal targets the opposite problem: administrative drag. The coalition wants a ceiling on penalties because physicians say the reporting burden has become out of proportion to the payment consequences. In practice, a system built to reward quality can become another source of overhead when the effort required to navigate it outstrips the financial signal it sends. For many smaller practices, even modest penalties can be amplified by staffing costs and declining reimbursement elsewhere in the schedule.
Payment policy can look technical on paper and still shape whether a practice can keep its doors open. A lower conversion factor may not sound dramatic until it lands in a clinic already wrestling with inflation, payroll, rent, and technology costs.
Inflation, penalties, and the economics of access
The coalition’s letter to congressional leaders argues that Medicare physician pay should move toward predictable, inflation-based updates. That approach is meant to align reimbursement with the actual cost of delivering care rather than forcing practices to absorb annual erosions in purchasing power. The current system does the opposite: it periodically offsets some pressure with temporary updates, then lets those boosts expire, creating a cycle of short-term relief followed by renewed cuts.
This is where patient access becomes the central clinical issue. When reimbursement falls far enough below practice cost, physicians may limit the number of Medicare patients they can see, shorten appointment availability, or defer hiring. None of those responses is visible in a fee schedule headline, but each can alter how quickly an older patient gets seen for chest pain follow-up, diabetes management, cognitive decline, or a post-discharge visit. In a program built to insure older adults and people with disability, access frays first at the edges and then in the middle of ordinary care.
The coalition’s push for a delay on the same-day visit reduction is especially relevant for primary care and other front-line specialties. Same-day care is often how physicians reduce missed diagnoses, close loops on abnormal results, and handle multiple active problems before a patient leaves the office. Penalizing that workflow can create friction in the exact setting where efficiency and continuity matter most.
Congress faces a year-end deadline with familiar tradeoffs
The timing of the request matters because lawmakers are being asked to act in the narrow window before year-end legislation is finalized. The coalition is using that deadline to argue that temporary fixes should not be treated as routine. By asking Congress to extend the 2.5% update, delay the same-day visit reduction, and cap MIPS penalties, the organizations are seeking a stopgap that would keep practices solvent while a longer-term payment model is debated.
There is also a broader strategic aim. A move toward predictable inflation-based updates would reduce the annual scramble around the physician fee schedule and make Medicare participation easier to plan for. Physicians do not run on macroeconomic abstractions; they hire staff, buy supplies, and book visits against the reimbursement schedule in front of them. When that schedule remains unstable, every downstream decision becomes harder.
The coalition’s argument rests on a straightforward premise: if Medicare payment keeps drifting below the cost of care, patients will feel it at the point of service. Congress now has to decide whether to provide another temporary shield or let the 2027 cut proceed as finalized.