AMGA Calls for Stable Medicare Payments and Regulatory Simplicity to Protect Patient Access

Alexandria, VA –AMGA today urged the Centers for Medicare & Medicaid Services (CMS) and Congress to take immediate action to stabilize Medicare reimbursement and reduce unnecessary regulatory complexity, warning that without lasting reforms, patient access to high-quality care will be at risk.

In comment letters responding to CMS’ proposed rules for the CY 2026 Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS), AMGA highlighted the financial and operational challenges facing multispecialty medical groups, integrated health systems, and hospitals nationwide.

“Temporary fixes and piecemeal payment updates only postpone a growing crisis,” said Jerry Penso, MD, MBA, president and CEO of AMGA. “Medical groups and health systems need predictable, adequate, and sustainable Medicare payment policies so they can continue delivering high-performance, high-value care to the patients and communities they serve.”

Key concerns outlined in AMGA’s letters include:

• Medicare Payment Instability: The proposed physician conversion factor and OPPS payment updates fail to keep pace with inflation, workforce shortages, and rising operating costs. AMGA called for structural reforms to align Medicare reimbursement with actual practice expenses and support coordinated, team-based care.
• 340B Program Cuts: CMS’ proposal in the OPPS to accelerate repayment of the 340B remedy through steep reimbursement cuts would devastate safety-net hospitals and ripple into Medicare Advantage payments, threatening access to care in rural and underserved communities. AMGA urged CMS to preserve the gradual repayment timeline. 
• Excessive Complexity: New efficiency adjustments, overlapping quality programs, and the proposed Ambulatory Specialty Model risk layering unnecessary administrative burden onto providers, diverting resources from patient care. AMGA stressed that regulatory simplicity must be a guiding principle to strengthen participation in high-value care.
• Support for Innovation: AMGA praised CMS for efforts to expand telehealth, remote monitoring, and advanced primary care codes, but emphasized that these reforms must be paired with stable, long-term payment policies to ensure they are sustainable.

“Stable reimbursement and streamlined regulation are essential for advancing high-value care,” Penso added. “Without these reforms, the very providers driving innovation and efficiency in our healthcare system will be forced to cut services, scale back participation in Medicare, or close their doors.”

AMGA urged CMS and Congress to work collaboratively on comprehensive payment reform that ensures reliable updates, reduces administrative burden, and strengthens the nation’s commitment to high-quality, accessible care for all Medicare beneficiaries.

The Physician Fee Schedule letter and the Outpatient Prospective Payment System letter are available on AMGA’s website. 

###

About AMGA

AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.