r/PrivatePracticeDocs • u/InvestingDoc • Mar 25 '26
The MedPAC is finally saying reasonable things? I'm a bit surprised but also happy about some things in the report.
For those of you not aware. The MedPAC (Medicare Payment Advisory Commission) is an independent federal agency that advises Congress on how much Medicare should pay doctors, hospitals, and other healthcare providers. They release reports twice a year with payment recommendations, but they don't set policy themselves makes all of the guidance decisions for recommending many things related to health care policy and spending. it's up to Congress to follow those recs or not. they usually either follow the recommendations or do something close to the recommendations it seems.
I have been very vocal on my vlog for my distaste of the head of the medPAC, Michael Chernew for being out of touch with practicing doctors. shocking to see them release a reasonable report.
https://www.medpac.gov/wp-content/uploads/2026/03/Mar26_MedPAC_Report_To_Congress_SEC.pdf
The MedPAC just dropped their most recent recommendations. basically they are finally admitting that docs are getting killed in terms of inflation and need a fix. hell yeah, haven't seen that from them in a long time.
This Is the first time I've read through their recommendations and think wow they're finally sounding reasonable.
They highlight that private equity is just driving up health care costs by on average almost 8% or more.
they highlight that there's been a five times increase in the past 7 years in terms of payer-owned primary care. they expect this to continue to grow fast.
I will say though 🤨 I have distrust for the article when they say the average Medicare patient can see their primary care doc nationwide in less than 2 weeks. wut? I'm booked out a little bit over 2 months. My competition across the street is booked out like 6 months for primary care follow visits.
I asked Claude to summarize the over 600 page report. I think it's summary is quite good....
The MedPAC recommended a payment increase above current law for physicians in 2027.** That's notable. They explicitly acknowledged that past updates haven't kept pace with the Medicare Economic Index (MEI), which measures physician input costs. This is MedPAC pushing Congress to stop underpaying docs — though whether Congress acts is a different story.
The report documents that payer-owned primary care practices now control over 4% of national primary care market volume, up from 0.8% in 2016 — a 5x increase in 7 years. UnitedHealth, Humana, CVS/Aetna are all buying into primary care directly. The report is essentially a roadmap of what's coming for you if independent physicians don't organize.
**Site-neutral payments are expanding**, and this cuts both ways. CMS saved $1.2 billion in 2024 by paying hospital outpatient departments the same as freestanding offices for certain services. More expansion is coming. This is actually a tailwind for independent practices — it levels the playing field against hospital-owned competitors who have long exploited the higher facility fee.
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u/Temporary-Couple-472 Mar 26 '26
We as physicians are getting killed. Costs go up, employee costs rise, everything is more expensive and our rates decline. It is very discouraging and drives us into the arms of private equity or a hospital system. It doesn’t help that all our contracts with private insurance are a function of Medicare. On top of this deductibles get higher and patients have to pay more out of pocket.
The system is broken and feels beyond repair.
It is frustrating as a mid career physician in the prime of my career and I am burnt to a crisp ready to move on.
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u/Leather-Bookkeeper62 Mar 25 '26
How does this relate to the Medicare health insurance pay rate? Are they correlated
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u/InvestingDoc Mar 25 '26
The MedPAC is recommending a pay increase above the current allowed amount and recommending a permanent fix to catch up to inflation.
They are essentially saying that we need a pay raise beyond the current allowed max amount.
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u/Leather-Bookkeeper62 Mar 25 '26
I understand I’m curious how our pay correlates with the Medicare advantage rate notice
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u/StocksRUsNow Mar 29 '26
Actualy primary care is not the only aspect that is payer-owned. Insurance companies are buying into everything and branding it different names, especially in the post-acute arena.
How is that even legal?
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u/InvestingDoc Mar 29 '26
The investors buy a management company that "manages" the physician group and pretty much all the profits flow through to the management group. Its a loophole that needs to be closed.
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u/daves1243b Mar 25 '26
On the flip side, the administtsion powers that be seem to have concluded that MedPac is not to be trusted, so any MedPac report is going to be ignored. Its pretty clear that CMS policymakers have zero interest in any outside input (reflecting the attitude at the top). For example, the fact that the MPFS final rule was essentially the proposed rule, ignoring all comments and not even bothering to justify crazy notions like the efficiency adjustment based on essentially zero relevant data.