CMS Proposes Medicare Physician Payment Overhaul to Boost Primary Care

The Centers for Medicare & Medicaid Services (CMS) released its proposed Calendar Year 2027 Medicare Physician Fee Schedule on July 14, 2026, outlining one of the more significant proposed overhauls to physician payment in recent years. The rule's central aim is to reweight reimbursement toward primary care and preventive medicine rather than reactive, procedure-driven care. CMS is soliciting comment on three specific primary-care proposals: reconsidering how primary care services are relatively valued within the fee schedule, addressing how technology-enabled primary care should be paid, and establishing a prospective, upfront primary care payment structure, first within the Medicare Shared Savings Program and potentially across Original Medicare more broadly.

The proposal also lays out a multi-year phase-out of the Merit-based Incentive Payment System (MIPS). Traditional MIPS would sunset beginning with the 2029 performance period, giving eligible clinicians until the end of 2028 to transition to a MIPS Value Pathway (MVP) unless they already participate in a MIPS Alternative Payment Model reporting the APM Performance Pathway. In the interim, CMS is proposing new MIPS Core Measures starting in 2027 along with three new MVPs focused on diabetes, hypertension, and hospital-based care.

A separate plank of the rule would expand participation in Accountable Care Organizations (ACOs) through the Medicare Shared Savings Program, a move CMS frames as accelerating the broader shift from fee-for-service care toward coordinated, value-based care. According to early coverage of the rule, it would also cut the physician fee schedule conversion factor by roughly 1.68% for non-qualifying APM participants (and about 1.19% for qualifying APM participants) versus CY2026, a detail that has drawn pushback from physician groups even as they welcome the primary-care emphasis.

CMS will accept public comments on the proposed rule through September 14, 2026, before finalizing the policy later this year for implementation in CY2027. How aggressively CMS ultimately pursues the MIPS phase-out and prospective primary-care payment pilots will depend heavily on feedback from physician groups, ACOs, and health systems during that comment window.

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