Join Fight Against Work RVU Cuts that Devalue Surgeon Services
On October 31, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Physician Fee Schedule final rule. In opposition to recommendations from the ACS and many healthcare organizations, the rule includes a 2.5% cut to work relative value units (RVUs) for almost all non-time-based codes starting on January 1, with additional reductions expected every 3 years—indefinitely.
This cut affects virtually every surgeon in the US, at least in part, without any change in workload. CMS has claimed that surgeons have become more efficient over time, performing procedures faster and with less intensity.
The ACS has been aggressively pushing back on this flawed decision. The College provided extensive comments on the 2026 proposed rule, and a number of ACS leaders published a study in the Journal of the American College of Surgeons showing that more than 90% of operations are taking just as long or even longer.
Despite these efforts and longitudinal data, the 2.5% cut remains; the only remaining option is to persuade Congress to stop this plan before it takes effect January 1.
On November 3, a letter organized by the ACS and signed by more than 30 national physician organizations was sent to all Senators and Representatives urging Congressional action.
If this cut takes effect, it could have dangerous and wide-ranging consequences. For example, physicians locked into multiyear employment agreements could face untenable financial strain, and the sickest and most complex patients may have limited access to care.
We strongly encourage you and all surgeons to register your voice with Congress through participation in the ACS SurgeonsVoice campaign. It takes only a few minutes, and the more voices that are registered, the greater the chance that Congress will listen. With the federal government shutdown now over, the College urges expanded efforts so that Congress prioritizes this issue.
So far, more than 2,500 surgeons from all 50 states have joined the ACS in the fight against work RVU cuts. Thank you if you are among them; please encourage your colleagues to participate.
In this video, Christian Shalgian, Senior Vice President of the ACS Division of Advocacy & Health Policy, summarizes the issue and explains how—and why—you should join the fight.
CMS Cuts Indirect Practice Expenses, Finalizes Ambulatory Specialty Model
CMS also finalized updates to its indirect practice expense (PE) methodology. Beginning on January 1, CMS will reduce the amount of indirect PE allocated per work RVU for facility services to 50% of the amount allocated for non-facility (office-based) services.
The ACS opposed this change and suggested potential alternatives, but these comments were not addressed in the final rule.
Additionally, CMS finalized the Ambulatory Specialty Model (ASM) to begin on January 1, 2027, and run for 5 performance years. This mandatory alternative payment model targets specialists who treat Original Medicare enrollees with low back pain or heart failure in an outpatient setting in certain geographical areas. The model is developed using components similar to the physician-centered Merit-Based Incentive Payment System (MIPS) Value Pathways (MVP), which are designed for fee-for-service Medicare payments, with alterations to the scoring framework.
The ACS urged a complete overhaul of the ASM in terms of both quality and cost metrics, stating that the model will not achieve goals of patient-centered, value-based care, but CMS declined to do so.
