Appalachian Physician Advisors

Repricing your CPT volume under the proposed 2027 Medicare Physician Fee Schedule is an important exercise. It is also incomplete. The proposed rule includes several policies that cannot be fully measured by simply comparing 2026 and 2027 RVUs. Some depend on which services are performed together. Some depend on who performs the work. Some depend on participation in an ACO. And others signal potential reimbursement changes that may extend beyond 2027. For physician executives

CMS may estimate that your specialty will gain 2%, decline 4%, or decline 7% under the proposed 2027 Medicare Physician Fee Schedule. That is useful information. It is not a financial forecast for your practice. Two physician groups in the same specialty can experience meaningfully different reimbursement changes because their procedure mix, volume, site of service, geography and Medicare contracting arrangements are different. For practice executives, CFOs and physician lead

When CMS released the proposed 2027 Medicare Physician Fee Schedule, one number was easy to focus on: the conversion factor. For most physicians and practitioners who are not qualifying participants in an Advanced Alternative Payment Model, CMS is proposing a 2027 conversion factor of approximately $32.84, down from approximately $33.40 in 2026 — a 1.68% decrease. For qualifying APM participants, the proposed conversion factor is approximately $33.17, a 1.19% decrease from 20

ANALYSIS & OBSERVATIONS | MEDICARE REIMBURSEMENT What the Data Reveal Across Care Settings, Orthopedics, and Total Knee Replacement Healthcare Finance & Strategy | August 2026 | Approximately 11-minute read Medicare payment pressure looks different when viewed across care settings, within a specialty, and at the individual-procedure level. Our analysis of national CMS data shows why conversion factors, service mix, site of care, and facility alignment must be evaluate

Cash flow problems in outpatient healthcare often get framed as revenue problems. Add providers. Raise rates. Open new sites. Push more volume through the schedule. Those moves can help, but they usually come with friction. More providers require recruiting, credentialing, payroll, space, and time. New locations need capital before they produce cash. Raising fees may create some incremental revenue, but it can also inflate contractual write-offs and make the top line look bet

The math is becoming hard to ignore. HRSA’s latest physician workforce projections estimate that the U.S. could face a shortage of 141,160 full-time equivalent physicians by 2038, with supply meeting only 88% of projected demand. That number is alarming on its own. The deeper problem is that the shortage will not hit every community or specialty the same way. HRSA projects shortages in 30 of 35 physician specialties reviewed. By 2038, physician supply adequacy is projected to

The PC-MSO model is not dead. But the captive version of the model is under real pressure. That distinction matters. A physician-owned professional corporation can still contract with a management services organization for nonclinical support. That basic structure has been around for a long time, especially in states with corporate practice of medicine restrictions. The harder question is whether the physician practice is independent in practical terms, or whether the MSO con

Provider taxes are one of the least understood pieces of Medicaid financing, yet they help keep parts of the program running in many states. Now they are back in the headlines because CMS is moving to tighten how states use them. The goal is straightforward on paper: reduce abuse, limit federal spending growth, and stop states from using financing arrangements that shift more Medicaid cost to Washington without real added state investment. The harder part is doing that withou

The Medicare Physician Fee Schedule conversion factor tells a simple story that many practices feel every day: nominal updates have not kept up with the cost of running a medical practice. In 2000, the Medicare conversion factor was $36.61. By 2025, it was $32.35. On paper, that is an 11.7% nominal reduction over 25 years. That number is already difficult to absorb. The real problem is inflation. Over the same period, consumer prices increased by roughly 87%. After adjusting