New Article Calls for Reform to Rebalance Medicare Physician Payments

A recent analysis in Health Affairs Forefront calls for CMS to reform physician payment to reflect the value of cognitive effort in primary care.

WASHINGTON D.C., DC, UNITED STATES, September 9, 2025 /EINPresswire.com/ -- A newly published article by health policy experts David Muhlestein, Yuvraj Pathak, and Samia Imtiaz urges the Centers for Medicare and Medicaid Services (CMS) to make reforms to how primary care is valued and paid for under the Medicare Physician Fee Schedule (MPFS). The article, published in Health Affairs Forefront, proposes four key policy recommendations for CMS, and calls for a re-evaluation of how the relative value units (RVUs) work components are calculated for primary care.

Despite a major reliance on primary care in the United States, primary care providers are in short supply - resulting in long wait times and reduced access, particularly for preventative and longitudinal care. The article highlights that one of the major drivers for limited access to primary care is the income gap between primary care providers and specialists.

The authors argue that the main reason primary care providers are underpaid is a result of how Medicare pays them. Under the MPFS, physicians are paid based on the resource-based relative value scale (RBRVS). "The work component under the RBRVS undervalues the effort needed to deliver effective care in primary care settings. Primary care often involves evaluation, diagnosis, counseling, and care coordination for patients with multiple chronic conditions. The work component does not accurately capture the value of this time-intensive, decision-oriented work typically performed by providers of primary care and other cognitive services", the authors note.

To address the undervaluation of primary care and revise the RVU work component, the article proposes four policy recommendations for CMS:
• Issue a policy statement recognizing that cognitive care has been undervalued and commit to raising its reimbursement.
• Increase RVUs for evaluation and management codes to better reflect the mental effort required. This is an action CMS can take under current law.
• Conduct a transparent, formal assessment of the physical and mental work involved in patient care, led by CMS or an independent third party, to address weaknesses in current RUC data.
• If needed, offset increases by reducing RVUs for lower-effort, procedure-heavy services.

Why This Matters
Access to primary care is associated with better health outcomes, reflecting the value primary care holds. Adjusting the work RVUs component to reflect the effort, time, and mental component of delivering this care is critical to ensuring that patients continue to have access to this crucial part of the healthcare system.

A Call to Action
CMS should recognize the crucial role of primary care by revising the work RVU component to reflect the mental effort required to deliver care.

About the Author
David Muhlestein, Ph.D., J.D., is a leading expert in healthcare policy and data analysis and the founder of Simple Healthcare, a firm dedicated to leveraging data-driven solutions to enhance transparency, efficiency, and affordability in the healthcare system. His work focuses on improving healthcare transparency, cost efficiency, and market dynamics. This research was supported by the Commonwealth Fund.

Ryan Carroll
Simple Healthcare
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