COA warns 2027 Medicare physician fee rule could hit independent cancer care

The Community Oncology Alliance is pressing CMS and Congress to reverse proposed 2027 Medicare payment changes it says would weaken community cancer practices and limit access to care. COA says the rule could cut pay for key oncology services and deepen instability in physician reimbursement.

Why it matters: - The Community Oncology Alliance says the proposed 2027 Medicare Physician Fee Schedule could make independent cancer practices less financially viable. - COA warns that if community oncology practices close or consolidate, patients could be pushed into higher-cost hospital settings. - Medicare and commercial insurers could end up paying more for the same or similar services if care shifts away from independent practices.

What happened: - COA submitted comments to the Centers for Medicare & Medicaid Services on the proposed Calendar Year 2027 Medicare Physician Fee Schedule. - The group is urging Congress to permanently update physician pay each year using the Medicare Economic Index. - COA is also asking CMS to rethink proposed cuts to conversion factors, practice expense payments and other physician payment policies. - Read COA’s full proposed 2027 MPFS comments: the full comments.

The details: - COA says practices face rising staffing, technology, equipment and other operating costs while CMS proposes lower practice expense payments. - CMS proposed lower conversion factors for 2027 after Congress provided temporary physician payment relief for 2026. - COA says the proposed RVU changes would cut community oncology payments by 2.12% overall based on its utilization analysis. - COA says the CMS estimate for oncology/hematology in the non-facility setting looks near neutral, but the group’s analysis shows bigger service-specific losses. - COA estimates payment reductions of about 5.06% for infusion, 4.28% for surgery and 10.06% for proton beam services. - COA president Debra Patt said physicians cannot operate practices when Medicare payment moves from one temporary fix to the next while costs keep rising. - Patt said Congress needs a permanent inflationary update and CMS must value services using current data and real patient-care conditions. - COA says CMS is also proposing changes to practice expense methodology, same-day evaluation and management services, complexity payments, remote monitoring and other payment components. - COA supports updating outdated Medicare data, but wants CMS to validate new methods against actual practice costs and provide code-level impact analyses. - COA strongly opposes a proposed 50% reduction for certain additional services performed on the same day, saying it could split coordinated care across more visits and add burden for patients. - COA opposes an automatic physician “efficiency” adjustment based on assumed efficiency gains rather than evidence that services now take less time or intensity. - COA supports recognizing complex, longitudinal care, but opposes tying higher payments to Medicare models that many community oncology practices cannot realistically join. - COA is asking CMS to use current evidence for proton therapy, oncology diagnostics and remote monitoring to protect access to specialized cancer services in independent practices. - The rule also includes new Medicare payment for planning for future medical decisions and expanded advance care planning services furnished by qualified clinical staff, which COA supports.

Between the lines: - COA says the proposal reflects a broader Medicare payment problem: temporary fixes are not keeping pace with real practice costs. - Ted Okon, COA’s executive director, said average payment changes can hide steep cuts to services that keep community cancer practices operating. - Okon said commercial insurers often follow Medicare’s payment methods, which can amplify the impact beyond Medicare. - COA points to radiation oncology as a warning sign for CMS payment changes made without enough real-world validation. - In 2026, CMS changed radiation oncology treatment-delivery codes using utilization assumptions that later diverged from actual claims experience. - COA estimates radiation oncology payment fell by about 23% from 2025 to 2026. - CMS now proposes using observed utilization to revise those payment values for 2027, and COA supports that correction. - COA estimates the proposed correction would raise radiation payment by only about 1.57%, which the group says does not offset the earlier drop. - COA says the radiation oncology experience shows why major coding and payment changes should be tested against real-world data before they take effect.

What’s next: - COA wants CMS to revise the proposed rule before it is finalized. - The group is pressing Congress to enact permanent, inflation-based physician payment reform. - COA says the next step should be a Medicare payment system that better reflects current costs and preserves independent cancer care.

The bottom line: - COA says the 2027 Medicare fee schedule could deepen instability for community cancer care unless CMS and Congress move to more durable payment reform.