Avicenna Medical Blog

Care Management Weekly News Update 11/6/25

Posted by DeAnn Dennis on Thu, Nov 06, 2025 @ 11:45 AM

The Centers for Medicare & Medicaid Services (CMS) released its annual physician pay rule for 2026 on Friday night, which increases physician reimbursement by 3.77% for qualifying providers in advanced alternative payment models and 3.26% for other providers. The bulk of the positive payment adjustment, 2.5%, comes from President Donald Trump's One Big Beautiful Bill Act enacted July 4. 

As hospitals and health systems brace for financial uncertainty tied to the One Big Beautiful Bill Act, one issue is drawing renewed focus: those who skip or delay care — often due to cost, coverage loss or access barriers. This concern was recently highlighted among seven pressing questions for health system leadership, amid efforts to prepare for the ripple effects of the legislation. Leaders said delayed or forgone care, while still difficult to quantify, is a strategic priority.

The Final CY 2026 Medicare Physician Fee Schedule (MPFS) marks one of the most consequential rulemaking cycles for remote monitoring since the creation of the original RPM (Remote Physiologic Monitoring) codes. For the first time, CMS finalized new CPT codes supporting shorter-duration monitoring, taking a major step toward more flexible reimbursement pathways for both RPM and RTM (Remote Therapeutic Monitoring) services.

Rural, poor communities' physician supply could be hardest hit by $100K H-1B visa fee, study finds

A new analysis of Department of Labor data suggests rural communities and those with higher levels of poverty will be disproportionately affected by the government’s new $100,000 fees for H-1B visa applications. Published Wednesday in JAMA, the study of H-1B applications found more than 11,000 of the country’s physicians, or just less than 1% of the national workforce, were sponsored for H-1B visas in the 2024 federal fiscal year (ended Sept. 30, 2024). 

Physicians criticize CMS’ efficiency adjustment

In the days after CMS finalized its 2026 physician fee schedule, dozens of physician organizations rebuked the rule and a 2.5% reduction the agency called an “efficiency adjustment.” Reimbursement under Medicare will shrink for more than 7,000 physician services, or 95% of all services provided by physicians, according to the American Medical Association, which has advocated for an alternative payment structure. 

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