CHICAGO — As the House Energy and Commerce Committee meets today to examine Medicare physician payment reform, the American College of Surgeons (ACS) urges policymakers to address growing instability in physician payment that threatens patient access to high-quality surgical care.
“Quality surgical care has been the cornerstone of the American College of Surgeons for more than 110 years,” said Patricia L. Turner, MD, MBA, FACS, Executive Director and CEO of the American College of Surgeons. “However, quality is not achievable without access. Continued instability and regulatory devaluation within the Medicare Physician Fee Schedule increasingly threaten patients’ access to timely surgical and specialty care.”
The ACS remains particularly concerned about recent regulatory and payment changes within the Medicare Physician Fee Schedule (MPFS) that disproportionately affect surgical and procedural specialties, including the Centers for Medicare & Medicaid Services’ (CMS) 2.5% efficiency adjustment to work Relative Value Units (wRVUs) for 2026.
The reductions are based on the flawed assumption that surgical care has become more efficient over time. However, recent research published in the Journal of the American College of Surgeons examining 1.7 million operations across 249 CPT codes found:
- Operative times increased 3.1% overall between 2019 and 2023
- 90% of procedures demonstrated the same or longer operative times
- Patient complexity increased across nearly every major measure
“These findings directly contradict the assumptions underlying the efficiency adjustment,” Dr. Turner said. “Surgeons today are caring for older, sicker, and increasingly complex patients.”
Beyond the efficiency adjustment, the ACS also warned that budget neutrality requirements within the MPFS continue redistributing resources toward primary care at the expense of surgical and specialty care.
“Our message is clear: shifting dollars to primary care does not guarantee better health outcomes, but it does risk limiting access to lifesaving specialty care,” Dr. Turner said. “Weak evidence must not drive policies that could undermine the care surgeons provide every day.”
The ACS emphasized that this debate should not be framed as a choice between primary care and specialty care.
“Patients need both primary care and timely access to surgical expertise,” Dr. Turner said. “This is not an artificial choice between the two. Any reform effort must strengthen the entire continuum of care without undermining access to specialty and surgical services.”
The ACS reinforces its advocacy with broader evidence-based policy analysis. Earlier this month, ACS leaders authored a Health Affairs Forefront article examining Medicare physician payment reform proposals and warning that continued redistribution under budget neutrality risks limiting access to specialty and surgical care without clear evidence of improved outcomes.
“The American College of Surgeons is committed to supporting our advocacy with evidence and data,” Dr. Turner said. “We are publishing new analyses, engaging directly with policymakers, and advancing solutions that protect both quality and patient access.”
