The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rule for the 2026 Medicare Physician Fee Schedule. And big changes may be coming to physician payments–including some potential for payments to primary care to increase, and for payments to many other specialties to decrease. This might be just what primary care needs.… Read More » Author information Gregory Stevens Professor at California State University, Los Angeles Gregory D. Stevens, PhD, MHS is a health policy researcher, writer, teacher and advocate. He is Chair of the Department of Public Health at California State University, Los Angeles. He serves on the editorial board of the journal Medical Care, and is co-editor of The Medical Care Blog. He is also a co-author of the book Vulnerable Populations in the United States. | Twitter | The post Could This Be What Primary Care Needs? appeared first on The Medical Care Blog.
The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rule for the 2026 Medicare Physician Fee Schedule. And big changes may be coming to physician payments–including some potential for payments to primary care to increase, and for payments to many other specialties to decrease. This might be just what primary care needs.
For those of us who care about the future of primary care and costs, this rule offers some potentially meaningful changes. I was inspired to look more closely at these changes by the thoughtful reporting of Reed Abelson and Margot Sanger-Katz at the New York Times. And to distill the roughly 1,800-page rule into useful information, I tapped AI to help find the biggest changes for primary and specialty care.
A new data foundation for physician work and practice expense
CMS is proposing to update the underlying data used to calculate physician payments. It will draw from the American Medical Association’s new Physician Practice Information and Clinician Practice Information surveys, and consider both work loads (which reflect time and intensity of physician labor) and practice expenses (which account for overhead like staff, equipment, and supplies). 
This is a long-overdue modernization.
The current inputs are outdated and often don’t reflect the realities of today’s clinical practice—especially for primary care, where time-intensive, cognitive work is often undervalued. If implemented thoughtfully, this could rebalance payments toward medical services that emphasize continuity, coordination, and complexity management. In other words, rewarding primary care.
The Medicare conversion factor continues to decline
In algorithmic terms, Medicare payments for different procedures and specialties are essentially adjustments to a basic payment number referred to as the conversation factor. The proposed conversion factor for 2026 is $32.36, down from $33.15 in 2025. This is not a surprise, but could be problem. The conversion factor has declined in real terms for years, eroding the value of Medicare payments (relative to private payments) and squeezing some practice margins. Primary care practices, already operating on thin margins, will probably feel this more acutely.
Primary care management: More useful codes, but also more complexity
CMS is proposing to expand payment for longitudinal care management, including new codes for services like chronic care management, principal care management, and behavioral health integration.
This is a step in the right direction. These services are foundational to high-quality primary care, especially for patients with multiple chronic conditions or social complexity. But the proliferation of codes and documentation requirements also risks overwhelming small practices. Simplification would be better, not just expansion.
CMS is also exploring how to better align these services with value-based care models. That’s encouraging, but the devil will be in the details—especially around attribution of patients, risk adjustment, and equity.
A new model for specialty care
CMS is also introducing the Ambulatory Specialty Care Model, a voluntary payment model aimed at specialists who manage complex, high-cost conditions. The model will include bundled payments, quality metrics, and shared savings opportunities.
This is likely a welcome development. Specialists have sometimes been sidelined in value-based care models. A tailored model might improve care coordination and reduce unnecessary utilization—if it’s smartly designed with clinician input and puts patient needs first.
Increased support for telehealth and supervision flexibility
CMS proposes to permanently allow direct supervision via real-time audio and video, a policy that originated during the COVID-19 public health emergency. This is a win for team-based care, especially in rural and underserved areas that have limited physician availability.
Telehealth services will also remain reimbursable under expanded codes, though CMS is still evaluating payment parity with in-person visits. For primary care, this flexibility supports access and continuity—but we may need to ensure it doesn’t exacerbate digital divides.
Incremental progress layered on top of a flawed system
The 2026 Medicare Physician Fee Schedule proposed rule reflects CMS’s ongoing effort to modernize physician payment—anchored in better data, expanded care management, and a new model of payment for specialty care. For primary care, there are meaningful steps forward: more support for longitudinal care, behavioral health integration, and telehealth flexibility.
But these changes layer atop a fairly structurally flawed payment system. A declining conversion factor, the increasing complexity of billing codes, and a reliance upon fee-for-service payments present challenges to efficient practice and sustainability. In the long-run, we may need a payment architecture that rewards the kind of care we say we want: patient-centered, delivering value not volume, and highly accountable for outcomes.
Note: The proposed rule is accepting public comments through September 12, 2025.
Author information
Gregory Stevens
Gregory D. Stevens, PhD, MHS is a health policy researcher, writer, teacher and advocate. He is Chair of the Department of Public Health at California State University, Los Angeles. He serves on the editorial board of the journal Medical Care, and is co-editor of The Medical Care Blog. He is also a co-author of the book Vulnerable Populations in the United States.
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