Medicare payment reform and compliance pressure threaten practice margins

CMS’s proposed 2027 same-day E/M policy could broadly reduce payment for overlapping services, alongside proposed MPFS changes, site-of-service differentials, prior authorization, outsourced RPM/RTM scrutiny, and preparation for the January 2027 cardiology acute specialty model. The PAM Health case highlights the need for dedicated Medicare Advantage appeals infrastructure. CEOs should quantify code-level exposure, redesign staffing and documentation, and attack revenue leakage and underused practice-management capabilities.