Congress has a chance to rethink Medicare pay, not just undo cuts

Congress has a rare chance to rethink how Medicare pays doctors, not just undo its latest cuts, said the leader of The Physicians Foundation.

Doctors elected to Congress can help make that case to leaders in Washington, D.C., said Gary Price, M.D., MBA, president of The Physicians Foundation.

Democrats retook the House and Senate in this month's midterm elections, and exit analyses found the cost of living topped voters' concerns. The advocacy leader says that concern cannot be separated from the cost of health care, which he believes has made both parties more willing to revisit how Medicare pays for care, said Price, who ran an independent surgical practice for years before retiring.

"This has been a bone of contention for physicians being able to take care of their patients now for quite a long time, with Medicare reimbursement not keeping pace with the cost of living, the cost of care," he said.

The congressional wins came just days before the Centers for Medicare & Medicaid Services (CMS) finalized the 2027 Medicare Physician Fee Schedule. This week Price discussed the latest developments in Washington with Chief Healthcare Executive, a sister publication of Medical Economics.

Can Congress rethink Medicare pay, not just the cuts?

CMS's final rule cut the 2027 conversion factor more than it had proposed, to $32.63 for most physicians and $32.95 for those in qualifying alternative payment models. The American Medical Association says that decline continues a longer slide that has left Medicare physician pay about a third lower than in 2001, after inflation. Price said the latest cut adds to frustrations that have built for years, and he's hoping the physicians now headed to Capitol Hill can carry that story further than advocacy groups alone have managed.

"I'm hoping for that physician ground-level voice of being able to bring the story of what happens to our patients as a result of this, is going to get a little bit more attention, and that story will get a little bit more energy directed towards making it better," Price said. He does not expect a quick fix, he said, but "every American now is looking forward to see what can be done going forward, because we heard there was willingness to do that."

Price also sees room for bipartisan agreement on Medicaid, particularly among Republicans representing districts with financially strained rural hospitals. Physicians in Congress, he said, aren't confined to one party.

"Physicians do come from all sides of the political aisle. They pretty much reflect the country in percentages in many ways," Price said. "But we all fundamentally want our patients to be well, to stay well, and do well. ... And that's a huge middle ground for at least the physicians on Capitol Hill to work from."

What is the negotiating gap costing independent practices?

More than 80% of U.S. physicians are now employed by a hospital, health system or other corporate entity, up from 52% in 2018, according to a Physicians Advocacy Institute analysis of IQVIA data current through January 2026. That shift traces partly to Medicare and private-insurance payment models that leave independent practices unable to negotiate, even though they often deliver care more efficiently than larger institutions, Price said.

He described an example from his own surgical practice: a major insurer in his state cut its reimbursement for breast reduction surgery so far below his costs that he had to limit how often he performed a procedure he considered a "godsend" for the patients who needed it. The same insurer, he said, paid a nearby hospital about four times as much for the identical procedure.

"Their policy just simply was, we don't negotiate with independent physicians, if you didn't have a bigger stick," Price said.

Is the physician pipeline running dry?

Physicians are retiring earlier than they used to, citing frustration with the conditions of practice rather than the work itself, Price said. He put the current average retirement age for male physicians at "right around 50," down from a career that not long ago often ran into physicians' 70s.

Burnout is a factor. In a 2025 Commonwealth Fund survey of primary care physicians in 10 countries, 43% of U.S. respondents reported burnout, the highest rate among the countries surveyed. Price said the fix has to include more graduate medical education funding, with more training time in rural and underserved primary care settings rather than large tertiary hospitals, and continued support for physician mental health programs such as the Dr. Lorna Breen Health Care Provider Protection Act. Congress reauthorized that act through fiscal year 2030 in February, but 73 medical organizations wrote to appropriators in March asking for at least $45 million in fiscal 2027 funding, so the law's financing, is still being negotiated.

"We need to restore the joy of practicing that kind of medicine that used to be present," Price said, "but now, we see this in survey after survey, with burnout rates ranging 40 to over 50%.

"What I really look to the physicians in Congress for is to bring the immediacy and the importance of the story to the halls of Congress," Price said. "And I think they have an advantage point and understanding of that story that's really far beyond what the average politician can imagine."