Navigating the 2026 MPFS Final Rule: Impact on Gastroenterology and Your Bottom Line

Video Transcription

Video Summary

The ASGE live stream discussed the 2026 Medicare Physician Fee Schedule Final Rule's impact on gastroenterology practices, highlighting critical changes and strategies to adapt. The rule includes a 3.26% increase in the Medicare conversion factor, offset by a 2.5% efficiency adjustment cutting work RVUs for non-time-based codes (primarily endoscopic procedures) and a 50% reduction in indirect practice expense reimbursements for facility-based procedures. These changes are projected to produce an 8% net decrease in reimbursements for hospital and ASC-based GI practices, equating to significant revenue losses per procedure.<br /><br />Panelists emphasized the disproportionate effects on different practice settings—facility-based procedures will be more affected than office-based ones. Strategies discussed included shifting endoscopy to office settings where feasible, with considerations of Certificate of Need laws and capital costs. Diversification through ancillary services like anesthesia, pathology, and ASC ownership was offered as a financial buffer.<br /><br />Physician compensation models tied strictly to work RVUs face challenges; hybrid compensation systems rewarding quality and efficiency are recommended to maintain physician engagement and retention. Operating efficiencies, staff optimization, supply chain management, and adopting technologies such as AI—particularly for patient intake and revenue cycle management—offer avenues to mitigate financial pressure.<br /><br />Advocacy was stressed as vital to influence future reimbursement policies. Transparency between physicians and billing teams regarding coding and payments is essential to capture revenue accurately. Community practices were advised to analyze their case mix and volumes, negotiate payer contracts strategically, and consider collaboration models like IPAs for improved negotiating leverage.<br /><br />Ultimately, the panel underscored resilience and adaptability, encouraging gastroenterologists to continue prioritizing patient care while innovating practice management amid a challenging reimbursement landscape.

Keywords

Medicare Physician Fee Schedule 2026

Gastroenterology reimbursement changes

Medicare conversion factor increase

Efficiency adjustment impact

Work RVUs reduction

Indirect practice expense cuts

Facility-based procedure reimbursement

Office-based endoscopy shift

Ancillary service diversification

Physician compensation models

AI in revenue cycle management

Advocacy for reimbursement policies