ACS Advocacy Brief: October 16, 2025

Protect Your Pay and Patient Access—Help Fight Back Against Cuts to Work RVUs

On July 16, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2026 Medicare Physician Fee Schedule (MPFS) proposed rule, which includes a new “efficiency adjustment” to work relative value units (RVUs). If finalized, this policy would reduce the work RVUs and intra-service time for all non-time-based codes by 2.5% in 2026, with additional reductions expected every 3 years indefinitely.

CMS contends that this adjustment reflects decreased physician time and work intensity as clinicians gain experience in certain procedures. However, recent research published in the Journal of the American College of Surgeons demonstrates the opposite: from 2019 to 2023, 90% of operative times studied have had longer or similar operative times, and all measures of patient complexity have risen. 

Accordingly, the ACS strongly opposed the proposal in its formal comment letter to CMS and highlighted significant implementation concerns. CMS proposes applying the adjustment even to codes that have been revalued within the past 5 years or are currently under review, while exempting all evaluation and management (E/M) services—despite similar efficiency dynamics applying to E/Ms, as well as non-time-based codes.

If finalized, this policy would have wide-ranging consequences, including resulting financial pressures that could limit patient access to surgical care, particularly for the most vulnerable populations.

The ACS detailed these and other objections in its letter to CMS. The final rule is expected from CMS on November 1. If CMS does not drop this proposal, then the only option would be for Congress to stop this before implementation on January 1. 

If you want to be among the first to know when the final rule is released and are interested in helping ACS efforts urging Congress to prevent these disastrous cuts, fill out this interest form. You will receive additional resources and action items to fight against work RVUs cuts, with efforts focused on the period after the final rule is expected to be released.

ACS Demands Physician Exemption to Proposed Visa Changes

In September, the US Department of Homeland Security proposed various changes to visa programs frequently used by international medical graduates (IMGs). The first proposal would establish a $100,000 fee for initiation of new H-1B visas, which would shut off a critical pipeline of highly trained physicians. With an expected workforce shortage of 124,000 physicians by 2036, it is imperative that the administration not hinder the ability for IMGs to serve in areas that benefit from additional support.

The ACS joined more than 50 other national health organizations calling on the administration to exempt physicians, medical residents, and other healthcare workers from this fee.

The second proposal is a shift from duration of status to fixed administrative periods for physicians who are J-1 visa holders. As currently drafted, the rule will greatly undermine the training and subsequent hiring of highly skilled IMGs and harm patients who rely on them for timely, high-quality care. 

The ACS joined more than 40 organizations requesting an exemption for physicians in order to preserve continuity across training, ensure uninterrupted clinical service, and provide reliable processing.

Healthcare Coalition Continues to Support Legislation on Physician Led Hospitals

The ACS recently joined a letter, along with nearly 90 other organizations, in support of the Physician Led and Rural Access to Quality Care Act. This critical, bipartisan legislation would empower physician-led hospitals to address challenges to care in rural communities. 

This legislation would allow new physician-led hospitals to be established in rural areas and offer high-quality care in underserved communities. Additionally, it would allow for the expansion of existing physician-led hospitals that are currently restricted under existing law. 

The ACS continues its strong support for this legislation and its goals of advancing timely and affordable care for patients in rural and underserved communities.

Resident Members: Apply for Travel Scholarships

If you are a Resident Member of the ACS who is interested in attending the 2026 ACS Leadership & Advocacy Summit—February 28–March 3 in Washington, DC—then you should apply for the ACS Resident Travel Award. The scholarship will cover up to $500 in housing and transportation costs. 

The summit will offer comprehensive and specialized sessions focused on effective surgeon leadership, as well as interactive advocacy training with coordinated visits to Congressional offices.

You must be a US-based Resident Member in good standing with the ACS to be eligible for the scholarship. The application deadline is Friday, November 14.

View Advocacy and Practice Management Courses from Clinical Congress 2025 On Demand

In addition to dozens of sessions that covered clinical and nonclinical topics relevant to all surgeons, the recent Clinical Congress 2025 had several sessions that focused on effective advocacy and enhancing your practice—and they remain available for conference registrants to view with the on-demand platform.

The Role of the Surgeon in Impacting Health Policy

Creating good health policy at the local and national level is not generally part of surgical education. This session provides details on:

• Ideas that make good laws or regulations that will benefit surgeons and patients
• Telling the story that can persuade legislators
• Leveraging grassroots advocacy efforts and effective engagement at federal and state levels

This session is moderated by Margeret C. Tracci, MD, FACS, the new ACS Medical Director for Surgeon Engagement.

Succeeding in TEAM—the Transforming Episode Accountability Model

This session is targeted at Fellows practicing in TEAM hospitals to provide timely information and advice on the new model. It explores the potential impact that ACS Quality Program participation could have on model performance and takes a detailed look at example hospitals using historical data.

Staying Engaged as a Community Surgeon: National Organizations, Networking, and Academic Pursuits

Surgeons in solo or small group practices, as well as those that work in rural or critical access settings, may find it difficult to stay engaged in nonclinical efforts such as research, education, and advocacy. This session reviews ways to stay engaged in the surgical community and promote professional growth for surgeons in community practice.

In addition, there are sessions on sustainable surgery, continuing medical education, robotic credentialing and privileging, prehospital trauma management, breast cancer screening, and much more that relate to policy, advocacy, and practice management. Log in or register today to begin watching.