The real-dollar value of the Medicare RVU, on which all physician payments are based, and many outpatient technical services, has been shrinking for years. A new 12-page report from "Committee for a Responsible Federal Budget" collates much of the history and argumentation, even when you disagree with its conclusions.
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The real-dollar value of the Medicare RVU has been shrnking for years - see a one-page update from AMA.
The advisory body MEDPAC will be discussing physician reimbursement adequacy at its December 4-5, 2025, meeting.
One recent major action by CMS was to reduce many technical valuations by a 2.5% "efficiency factor" effecting January 2026, allowing funding to be redistributed towards primary care E&M claims. See e.g. a summary at Holland and Knight here.
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An entity called "Committee for a Responsible Federal Budget" releases a 12-page white paper, in which it supports the "efficiency discount." Find it here:
https://www.crfb.org/sites/default/files/media/documents/HSI%20PFS%20Final.pdf
While many readers will oppose that conclusion, I'm highlighting the 12 page white paper because it contains an extensively footnoted discussion of the history and present status of a range of issues - from the "efficiency' debate to the overall RVU deflation to the way that growing numbers of Nurse Practitiioners and other professionals are billed (direct vs incident-to).
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The big beautiful bill (HR 1) of July 2025 will lead to some changes in whether and how certain health care graduate students can borrow education funds, from 2026 forward. In a nutshell, a limited number of degrees will be considered "professional" (law, medicine, dentistry, master's in theology for ministers). Others, like nurse practitioners, will not be. (Degrees like MBA or MPH will be officially classed as "non professional" with lower federal loan caps.) From my general knowledge we want to encourage the production of N.P.s and other kinds of primary care - hopefully this will continue to be revisited.
