More than two-thirds of respondents—67%—said they would have to see fewer Medicare patients, and 14% said they would have to stop accepting Medicare entirely.
"Physician practices are already being squeezed from every direction," said Rahul K. Shah, MD, MBA, AAO-HNS chief executive officer and executive vice president. "Years of inadequate Medicare payment have made it harder to keep staff, invest in care, and maintain patient access. Now CMS is proposing to pay half for medically necessary work that physicians perform in full. At some point, the math stops working—and when that happens, every patient in the practice feels it."
The survey found potential effects that extend beyond how many patients physicians can see:
- More than 84% said the proposal could lead to longer appointment wait times, fewer referral options, and greater difficulty obtaining timely specialty consultation.
- More than 82% said it could delay care in ways that affect patients' quality of life.
- Nearly 82% anticipated decreased access to certain in-office procedures.
- More than 81% expect greater inconvenience for patients with transportation or mobility challenges.
- More than 56% foresee higher out-of-pocket costs for patients.
If finalized, the CMS proposal could add to the financial pressure practices already face from years of Medicare cuts. Some may respond by taking more patients with commercial insurance, accepting fewer Medicare patients, reducing services or staffing, joining larger health systems, or closing. The consequences could be particularly severe in rural and underserved communities, where practices have less flexibility to absorb further Medicare cuts.
Proposed Cut Could Penalize Same-Day Care
The CMS proposal targets Modifier -25, which is used when a physician provides a separate medical evaluation and procedure during the same visit.
For patients, that can mean getting needed care in one appointment instead of returning another day. A patient with symptoms raising concern for head or neck cancer, for example, may be evaluated and have an in-office procedure during the same visit. This helps avoid added delay, travel, cost, and anxiety.
Under the proposed 2027 Medicare Physician Fee Schedule, CMS would pay the higher-cost service in full and cut payment for the other service by 50%. In many cases, payment may not cover the cost of the staff, supplies, and equipment for the service.
CMS says the proposal is meant to address possible duplicate payments. However, CMS acknowledges in the proposed rule that the current payment system already accounts for work that overlaps when services are provided together. The agency does not provide evidence showing a 50% overlap in the remaining work.
Physicians pointed to a range of changes for their practices if the policy is finalized:
- 50% said they would spend more time on documentation and administrative work.
- 50% said they would delay investments in technology, equipment, and training.
- 30% said they would need to lay off staff.
- 18% said they would need to hire additional coding or billing staff.
"The care does not become less important because it happens on the same day as a procedure," said Academy President Eugene Brown III, MD, RPh, CEO of Charleston ENT & Allergy and its 17 locations in South Carolina. "If I evaluate an older patient and find something concerning, I may be able to begin the next step in that evaluation right then. I am still doing the same careful work, making the same medical decisions, and taking the same responsibility for that patient. Paying half for that care undervalues what physicians are actually doing for our seniors."
The AAO-HNS and nearly 20 national physician and patient organizations in the Same Day Care Coalition are urging CMS not to finalize the proposed 50% payment cut. The coalition is asking CMS to fully evaluate the impact on patient access, timely treatment, and physician practice sustainability before making changes.
About the Survey
The AAO-HNS surveyed members online from July 28 to August 13 and received 1,406 responses. Learn more about the Academy's Medicare patient access efforts and read the survey results.
About the American Academy of Otolaryngology–Head and Neck Surgery
The AAO-HNS and its Foundation represent approximately 13,000 physicians and other professionals who treat the ears, nose, throat, and related structures of the head and neck. Otolaryngologist–head and neck surgeons diagnose and treat conditions affecting patients of all ages and help people breathe, hear, speak, sleep, swallow, and connect with the world.
Together, the Academy and Foundation advance the specialty through education, research, quality improvement, advocacy, humanitarian programs, and initiatives that shape the future of patient care.
