12 physician societies back Medicare payment fix for office-based care

A coalition of 12 national physician specialty societies is urging Congress to pass H.R. 7863, a bipartisan bill aimed at fixing Medicare payment rules that are pushing independent practices to close and sending patients to higher-cost hospital settings. The measure would create a new payment path for office-based procedures and could preserve lower-cost care in rural and underserved communities.

Why it matters: - The coalition says Medicare’s current payment rules are driving independent physician practices out of business. - The result is more care shifting to hospitals and hospital outpatient departments, where the same procedures often cost Medicare two to three times more. - Rural and underserved communities could be hit hardest because office-based practices are often the only nearby source of interventional care.

What happened: - A coalition of 12 national physician specialty societies announced support for H.R. 7863, the Promoting Fairness for Medicare Providers Act. - The bipartisan bill was introduced in the 119th Congress by Reps. Gus Bilirakis, R-Fla.; Raul Ruiz, M.D., D-Calif.; Greg Murphy, M.D., R-N.C.; and Danny K. Davis, D-Ill. - The coalition sent a formal letter of support to the bill’s sponsors. - The societies represent physicians in interventional cardiology, vascular surgery, interventional radiology, radiation oncology, urology, nephrology, pain management and venous medicine.

The details: - Medicare’s Physician Fee Schedule was built to reimburse physician professional work, not the high-cost supplies and specialized equipment used in many office-based procedures. - In 2025, Medicare reimbursement fell below the direct cost of care for more than 300 common office-based CPT codes, before overhead, malpractice or physician work. - Office-based reimbursement for those procedures has fallen 22% since 2019. - Hospital outpatient rates for the same services rose 22% over the same period. - Hospital outpatient departments are paid an average of 124% more than independent offices for the same 300 underpaid procedures. - H.R. 7863 would create a new “Office-Based Facility” payment category for surgical procedures with supply costs above $500. - The bill would pay 90% of Ambulatory Surgery Center rates using annually updated, auditable cost data. - The legislation would remove high-cost medical supplies from the Physician Fee Schedule practice expense methodology. - The coalition says that methodology relies on survey data from 2008 and can cut actual practice expense costs by up to 58% before reimbursement is calculated. - The bill is intended to preserve office-based care in places where hospitals and ambulatory surgery centers are not available. - The measure is also designed to keep office-based care Medicare’s lowest-cost site of service and protect Medicare’s fiscal sustainability.

Between the lines: - The fight is about more than physician payment levels. - The coalition is framing the bill as a structural correction to Medicare’s pricing system, not a temporary patch. - Supporters argue the current model rewards higher-cost hospital care even when the same service can be delivered safely in a medical office. - The push reflects a broader battle over consolidation in health care as independent practices struggle with rising supply costs and weak reimbursement.

What’s next: - Congress will have to decide whether to advance H.R. 7863 in the 119th Congress. - If lawmakers act, the bill could change how Medicare pays for office-based procedural care and affect access for millions of Medicare patients. - The coalition is pressing Congress to move quickly to avoid more independent practice closures.

The bottom line: - The physician coalition wants Medicare to pay office-based practices enough to survive, arguing that doing so would preserve patient access and slow the shift to more expensive hospital care.