On Thursday, June 12, the June 2025 Medicare Payment Advisory Commission (MedPAC) Report to Congress was released. MedPAC is an independent Congressional agency and advises Congress on issues affecting the Medicare program. Its recommendations are not law, but they are influential with lawmakers. The June Report contains seven chapters, and of particular interest to ASTRO members is Chapter 1: Reforming physician fee schedule updates and improving the accuracy of relative payment rates. In this chapter, the Commission recommends replacing the current law updates to the Medicare Physician Fee Schedule (MPFS) with an annual update based on a portion of the Medicare Economic Index (MEI) (for example, MEI minus 1%) and to improve the relative accuracy of MPFS rates by collecting and using timelier data.

Under current law, beginning in 2026, MPFS rates will increase by 0.75% per year for qualifying physicians in advanced alternative payment models and by 0.25% for all other clinicians. However, costs as measured by the MEI are projected to increase 2.2% per year from 2025 through 2034. The Commission is concerned this gap will cause some clinicians to reduce the number of Medicare beneficiaries they treat or lead to more practice consolidation.

MedPAC is also concerned about misvaluation of the MPFS relative value units (RVUs). In addition to recommending updating the data used to calculate RVUs, the Commission is considering how to more accurately pay for indirect practice expenses. It believes that Medicare overpays for services furnished in a facility since many clinicians now have little or no overhead expenses because they do not maintain independent offices. However, under the Hospital Outpatient Prospective Payment System, an additional facility payment for overhead costs is included.