ACS Advocacy Brief: July 2026

A Message from Patricia L. Turner, MD, MBA, FACS, Executive Director & CEO and Christian Shalgian, SVP, Health Policy and Advocacy

Advocacy is rarely measured by a single victory or a single setback. More often, it means improving proposals before they become law, opposing policies that threaten surgeons and their patients, and continuing to pursue better solutions when progress falls short.

Much of that work happens long before legislation is introduced or regulations are finalized. Some of the ACS’s most important successes occur through conversations, negotiations, and the thoughtful sharing of surgical expertise that improve proposals before they ever become public. Those efforts are not always visible, but they are essential.

This week brought three significant federal developments affecting surgeons. Together, they demonstrate both the challenges facing our profession and why sustained engagement with Congress, Centers for Medicare & Medicaid Services (CMS), and federal agencies remains so important.

While not every outcome is what surgeons need, remaining engaged gives us the opportunity to make policy better than it otherwise would have been and to continue improving it. Meaningful reform requires persistent engagement, credible expertise, and a willingness to stay at the table. The ACS is working aggressively to do this on behalf of all surgeons and the patients we serve.

Below is an update on these important issues, the ACS’s continued advocacy, and how you can help.

Medicare Payment Reform Is Legislation Introduced

On July 15, Representatives John Joyce, MD (R-PA), Greg Murphy, MD, FACS (R-NC), and Kim Schrier, MD (D-WA), co-chairs of the GOP Doctors Caucus and Democratic Doctors Caucus, introduced the bipartisan Patients First Act of 2026, legislation intended to begin modernizing the Medicare Physician Fee Schedule.

The legislation includes several long-standing priorities of the ACS and the physician community, including establishing an annual inflationary payment update and increasing the budget neutrality threshold to help reduce unnecessary across-the-board payment cuts.

These reforms represent meaningful progress toward improving the long-term stability and predictability of Medicare physician payment. The bill also includes broader reforms to the Medicare Access and CHIP Reauthorization Act (MACRA).

However, the legislation falls short of what surgeons need.

It does not currently address several pressing challenges facing surgeons, including

CMS’s harmful "efficiency" adjustment to work RVUs and the Medicare physician payment reductions scheduled to take effect in 2027.

Engagement from the ACS and surgical coalition partners resulted in a stronger piece of legislation being introduced. The efforts to improve and refine the legislation will continue until the end of the calendar year.

The ACS thanks Reps. Joyce, Murphy, and Schrier for their leadership in introducing bipartisan physician payment reform. The College appreciates lawmakers' willingness to engage with the surgical community and will continue working with Congress to strengthen the legislation as it moves forward.

While the ACS continues to work to improve the Patients First Act of 2026, the ACS continues to strongly support the Efficiency Adjustment Delay Act, which was sponsored by Rep. Ron Estes (R-KS).

Take action—Use SurgeonsVoice to ask your Members of Congress to cosponsor the Efficiency Adjustment Delay Act and stop harmful cuts to work RVUs.

CMS Proposes MPFS Changes That Raise Significant Concerns for Surgeons

On July 14, CMS released the proposed 2027 Medicare Physician Fee Schedule (MPFS), which includes payment reductions and several policy changes that could significantly affect surgeon reimbursement, surgical practice, and Medicare quality programs.

CMS proposes reducing the Medicare conversion factor by 1.19% for qualifying Alternative Payment Model (APM) participants and 1.68% for all other physicians. While these reductions largely reflect the expiration of the temporary payment update Congress provided for 2026, the proposal goes far beyond the annual payment update.

The agency proposes reducing payment for separately identifiable evaluation and management (E/M) visits provided on the same day as a global surgical procedure and is seeking comments on changes that could further diminish physician input into how physician services are valued. Although CMS did not propose cuts to global codes for CY 2027, CMS signals continued interest in revaluing global surgical codes by reopening questions about the postoperative visits included within global payments.

The agency also proposes reducing payment for separately identifiable E/M visits provided on the same day as a global surgical procedure and is seeking comments on changes that could further diminish physician input into how physician services are valued.

The proposed rule also includes significant changes to Medicare's Quality Payment Program. CMS proposes phasing out traditional Merit-Based Incentive Payment System (MIPS) after the 2028 performance year, making MIPS Value Pathways (MVPs) the primary reporting option for clinicians who are not participating in Advanced APMs beginning in 2029.

While CMS proposes several MVPs relevant to surgical specialties and is seeking input on the future role of specialty care and digital quality measurement, these changes represent another significant shift in how surgeons will participate in Medicare quality programs. Read more details about the concerning MPFS provisions.

Protecting the Scientific Foundation of Surgical Care

This week, the ACS submitted formal comments opposing the Office of Management and Budget's (OMB) proposed rule governing federal financial assistance.

For more than a century, science, evidence, and innovation have been foundational to the ACS. Research advances patient care, drives surgical innovation, and saves lives across every surgical specialty. The proposed rule threatens that foundation.

Among its most concerning provisions, the rule would allow political appointees to override expert peer review in grant funding decisions, require research programs to align with shifting political priorities, expand the government's authority to terminate research grants, restrict scientific collaboration, and create additional barriers to sharing research findings.

Collectively, these changes would undermine the independent, merit-based research enterprise that has produced generations of advances in surgical care.

The ACS’s comments urge OMB to preserve independent, merit-based peer review and protect the scientific framework that has guided surgical research for more than a century.

Scientific progress depends on rigorous evidence, expert review, and stable investment over many years, not shifting political priorities. Those principles have enabled surgeon-scientists to develop new treatments, refine surgical techniques, and generate evidence that improves care for every patient. Protecting that process is essential to the future of surgery.

Although the public comment period has closed, advocacy continues.

Use SurgeonsVoice to urge your Members of Congress to protect independent, merit-based scientific research and preserve the peer-review process that has driven generations of medical discovery.

ACS Advocacy Will Not Stop

Advocacy does not end when legislation is introduced or a public comment period closes.

In the weeks ahead, the ACS will continue working with Congress to strengthen Medicare physician payment reform, submit detailed comments on the proposed Medicare Physician Fee Schedule, and advocate for policies that protect scientific integrity and support continued surgical innovation.

Your voice remains one of the most effective advocacy tools.

Whether contacting your elected officials, responding to an ACS advocacy alert, or sharing your experience caring for Medicare patients, your engagement strengthens our collective impact and helps ensure that the voice of surgeons continues to be heard.

Thank you for standing with us as the ACS continues advocating for surgeons and the patients we serve.

Medicare Physician Fee Schedule Proposed Rule Breakdown

On July 14, CMS released its annual MPFS proposed rule, which would update payment policies for services furnished on or after January 1, 2027. CMS proposes a 2027 conversion factor of $33.17 for qualifying APM participants (QPs), a decrease of 1.19%, and $32.84 for non-QPs, a decrease of 1.68%. The cuts largely reflect the expiration of the 1-year 2.5% payment increase Congress provided for 2026. The rule contains several proposals with significant implications for surgical payment, some of which are described below.

Global surgical codes. CMS proposes to pause the collection of data on postoperative visits reported with CPT code 99024, a requirement established under MACRA to verify the number of postoperative visits furnished during the global period. While the agency acknowledges the reporting requirement is burdensome, it believes that data show postoperative visits during the global period are not occurring, even as providers continue to be paid for those visits. CMS is publishing a public use file displaying imputed RVUs for the postoperative visits bundled into 10- and 90-day global codes and is soliciting comments on expanded data collection, alternative data sources, and revaluation strategies it may pursue through future rulemaking, signaling continued interest in revaluing global codes.

Same-day E/M visits. CMS proposes to reduce payment when a separately identifiable office/outpatient E/M visit is furnished by the same physician, or a physician in the same practice, on the same day as a 0-, 10-, or 90-day global procedure. The highest-valued service, whether the procedure or the E/M visit, would be paid at 100%, and all other services furnished that day would be paid at 50%.

E/M complexity add-on (G2211). CMS proposes to convert HCPCS code G2211, which provides separate payment for office/outpatient E/M visit complexity, from a standalone code to a modifier appended to the E/M base code. Rather than the current flat payment, the modifier would increase payment for the associated E/M code by 16%, maintaining an equal percentage increase across all E/M levels. CMS also proposes a second modifier, available only to practitioners in Shared Savings Program or LEAD Model ACOs, that would increase payment for the associated E/M visit by 32%.

Physician input into valuation. For nearly 20 years, MedPAC has raised concerns about the influence of the AMA/Specialty Society RVS Update Committee (RUC) in valuing services, asserting that CMS has "over-relied on specialty societies with a financial stake in the process." Citing these concerns, CMS is seeking comments on the role of the CPT^® coding system and the AMA process in physician payment policy. Relatedly, CMS is proposing to continue shifting its practice expense methodology away from AMA survey data, including phasing out the step that ties specialty-level practice expense RVUs to survey data from 2007 or earlier.

Updates to Quality and Value-based Payment Program in CY 2027 Medicare Physician Fee Schedule Proposed Rule

The MPFS rule also provides annual updates to the Medicare Shared Saving Program (MSSP) and 2027 Performance Year of the Quality Payment Program (QPP), which encompasses the MIPS, MVPs, and participation in Advanced APMs. Proposals within this rule reinforce CMS’s goals of having 100% of people with Traditional Medicare in an accountable care relationship by 2030.

As part of the QPP, CMS proposes major changes that would transition clinicians away from MIPS by sunsetting traditional MIPS after the 2028 performance period. If finalized, beginning in 2029, MVPs would be the only MIPS reporting option for MIPS eligible clinicians not in an APM. MVPs include subsets of measures and activities related to a specific specialty or medical condition. 

CMS proposes three new MVPs for 2027; if finalized, there will be a total of 30 MVPs available for 2027 reporting. Of the 30 available MVPs, seven align with surgical specialties or surgical episodes of care: the Surgical Care MVP, Improving Care for Lower Extremity Joint Repair, Vascular Surgery MVP, Complete Ophthalmologic Care, Optimal Care for Patients with Urologic Conditions, Quality Care for the Treatment of Ear, Nose, and Throat Disorders, and Focusing on Women's Health.

The proposal extends beyond physician payment. CMS also proposes numerous updates for Accountable Care Organizations (ACOs) in the MSSP that intend to strengthen financial incentives for ACOs to participate in the program. 

Finally, the proposed rule includes multiple requests for information (RFI), including an RFI on the role of specialty care in the MSSP and an RFI on a phased transition from existing quality measures to digital quality measures by 2030. 

The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule and related QPP fact sheet and SSP fact sheet are accessible online for public review. Contact regulatory@facs.org with questions.