Summary
How Medicare pays for services is pretty wonky stuff, but it has huge impacts on how health care businesses operate. The 2026 Medicare Physician Fee Schedule (MPFS) is especially interesting this year because of how many areas it touches and how dramatically it changes Medicare payments — a rare occurrence for the first MPFS rule of a new administration.
HTN hosted Lauren Makhoul, Director, M&A Advisory, Sean Dillon, Director, M&A Advisory, and Amy Hunsberger, Special Counsel, from Manatt Health to discuss the rule-making process, the controversial efficiency adjustments and practice expense changes, and the prescription drug components of the rule. A fee schedule is, in many ways, a statement of priorities, and it was fascinating to see hear how the new administration’s priorities are getting implemented through this final rule.
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What we covered:
00:00 Introduction to the Medicare Physician Fee Schedule
00:24 Understanding the Medicare Physician Fee Schedule
01:20 The Rulemaking Process Explained
04:59 Conversion Factor and RVUs
09:47 Budget Neutrality and Statutory Increases
14:00 Efficiency Adjustments and Their Impact
19:31 Practice Expense Methodology Changes
25:05 Medicare Shared Savings Program and ACO Reach
27:20 Prescription Drugs in the Fee Schedule
35:02 Skin Substitutes and Reimbursement Changes
40:36 Upcoming Rules and Final Thoughts