CHICAGO — The Centers for Medicare & Medicaid Services (CMS) is recommending a 2.5% “efficiency adjustment” payment reduction in the proposed 2026 Medicare Physician Fee Schedule based on the assumption that surgeons are faster today in completing procedures than they were five years ago. However, a new research letter published in the Journal of the American College of Surgeons (JACS) shows that overall operative length and complexity have actually increased since 2019.
Researchers analyzed data on more than 1.7 million operations, spanning 249 Current Procedural Terminology (CPT) codes and 11 surgical specialties, from the American College of Surgeons National Surgical Quality Improvement Program. They found that 90% of CPT codes had the same or longer operative times in 2023 compared to 2019. Additionally, operative times increased overall by 3.1%.
“This is a novel approach by CMS when it comes to physician payment, so we wanted to test it and see if the data actually support this type of monumental shift in payment policy,” said Christopher Childers, MD, PhD, lead author of the analysis and an assistant professor of hepato-pancreato-biliary surgery at the University of Washington School of Medicine in Seattle, Washington. “Our analysis suggests the opposite is true, with 9 in 10 common surgical procedures taking similar or longer compared to five years ago. There are many possible reasons for these results, and they warrant further examination before a policy like this is implemented.”
Throughout the study period, patient complexity also increased. The authors looked at a variety of preoperative and postoperative measures of complexity, such as patient age, comorbidity burden, and rates of complications. Across all of these domains, patient complexity increased between 2019 and 2023. Despite this, the authors found that 30-day mortality for these patients did not change.
The proposed “efficiency adjustment” would reduce work relative value units assigned to non-time-based CPT codes by 2.5% in 2026, with subsequent adjustments every 3 years.
“As surgeons, we always strive to be as efficient as possible in our efforts to deliver optimal surgical care for our patients. This analysis shows that patient complexity has increased over the last five years and, as a result, this proposed payment change does not reflect the reality of our practice every day,” said Patricia L. Turner, MD, MBA, FACS, Executive Director & CEO of the American College of Surgeons. “It is our expectation that CMS will review this thorough examination of clinical data and understand that patient care will suffer if this adjustment is part of the Medicare Physician Fee Schedule for 2026.”
Co-authors of the research letter are Lauren M. Foe, MPH; Vinita Mujumdar, JD; Charles D. Mabry, MD, FACS; Don J. Selzer, MD, MS, FACS; Christopher K. Senkowski, MD, FACS; Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS; and Thomas C. Tsai, MD, MPH, FACS.
Author disclosures: Dr. Tsai receives consulting fees from Johnson and Johnson, MedTech, and Ginkgo Bioworks.
Citation: Childers C, Foe L, Mujumdar V, et al. Longitudinal Trends in Efficiency and Complexity of Surgical Procedures: Analysis of 1.7 Million Operations Between 2019 and 2023. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001588
The analysis is published as an article in press on the JACS website.
