“Fixing the Formula: How CMS’s 2026 Proposal Could Revive Community-Based Care”
The CardioVascular Coalition (CVC)
For years, office-based interventional providers — many of them independent physicians serving rural and underserved communities — have faced a slow and steady erosion of reimbursement under the Medicare Physician Fee Schedule. These are not large hospital systems; they are the small, patient-centered practices that deliver life-saving care for those without access to large hospitals. Yet the system has long penalized these small practices with inequitable practice expense (PE) policies that fail to reflect the real cost of modern care delivery.
That’s why the Centers for Medicare & Medicaid Services’ (CMS) proposal to modernize the indirect practice expense methodology in the CY 2026 Physician Fee Schedule represents a long-overdue and meaningful step forward. It’s the first substantive correction in years that could help restore fairness, stability, and access to medical care across the country.
The proposed update acknowledges what independent providers have known for years: the current practice expense structure of the Physician Fee Schedule systematically disadvantages office-based practices. Over the last several years, office-based providers have endured payment cuts of 20–40%, forcing some to close their doors or consolidate into hospital systems — driving up costs, reducing patient choice, and disproportionately impacting rural and underserved communities.
As Dr. Paul Gagne, a board member of the CardioVascular Coalition (CVC), put it: “For too long, the system has penalized office-based practices that deliver high-quality, cost-effective care. This policy update will help stabilize community-based interventional care and ensure patients — especially those in rural and underserved communities — can continue to receive treatment close to home.”
By modernizing the Physician Fee Schedule practice expense methodology to reflect contemporary practice trends, CMS is not only correcting a technical imbalance — it is reaffirming a policy principle: that appropriate payment should follow the patient, regardless of site of service. The new approach also moves away from outdated and unreliable data sources such as the AMA’s most recent Physician Practice Information Survey (PPIS), which would have disproportionately benefited hospital based providers at the expense of community based practices if left unchallenged.
There is still work to do. CVC and its member organizations continue to call for broader payment reforms that sustain office-based care. However, the policies contained in the 2026 Physician Fee Schedule are promising signals that CMS recognizes the essential role of independent providers in a sustainable, accessible, and patient-centered healthcare system.
As Dr. Gagne noted, “The 2026 PFS proposed rule sends a strong signal that CMS recognizes the vital role of independent, office-based providers. This is a long-overdue correction that will help preserve patient choice and protect the future of community-based medicine.”
CMS deserves credit for listening — and for taking a step toward fairness that patients across America will feel.
