For nearly four years in the Missouri House of Representatives, I’ve worked to make sure that all Missourians, particularly rural Missourians and seniors, don’t get left behind when it comes to healthcare. I’ve sponsored legislation to keep rural hospitals open, expand access to physician care in underserved areas, and push back against the consolidation that’s been quietly hollowing out our healthcare system for years.

But now, there’s a federal policy that threatens to undo some of that progress. 

The Centers for Medicare & Medicaid Services (CMS) 2026 Physician Fee Schedule reduced the reimbursement for physicians that work in facilities. The aim was to crack down on the exact consolidation I’ve fought against, where hospital systems purchase physician practices and shift their billing to higher-cost hospital outpatient departments. All it does is increase Medicare spending without any improved results. It was the right call to address this. 

But the policy got something wrong. Skilled nursing facilities (SNFs) were among the facilities where physicians would see reduced payments.

The policy assumes that physicians in facilities don’t have meaningful practice costs like staff, care coordination, or billing because the facility covers it. And while that is true for hospital-employed physicians, that’s not the reality for independent physicians that serve SNFs. 

Independent physicians serving SNFs are responsible for their own practice expenses. The facility doesn’t cover any of it, and reimbursing physicians as if they do has real ramifications on both patient care and future consolidation. 

CMS can fix this in the 2027 Physician Fee Schedule.

In the existing fee schedule, under Place of Service 32, CMS has recognized that physicians incur real practice costs when serving nursing facilities, so physician payments reflect the total costs associated with providing care. Applying that same standard to SNFs under Place of Service 31 would correct an inconsistency that doesn’t accurately reflect either care costs or how care is delivered in SNFs. 

For patients, this policy will reduce access to physician care in SNFs. As reimbursement is reduced, independent physicians serving SNFs may find that the financials don’t work to continue serving the facilities. And seniors, many of whom are managing multiple conditions and relying on consistent physician care to recover and return home, are the ones who pay the price.

In many of our smaller, rural communities, there isn’t a backup provider. Our seniors don’t have options. And after years of hospital closures, physician shortages, and dwindling healthcare infrastructure in rural Missouri, this policy adds more strain to communities that have already lost too much.

More broadly, when independent physicians serving SNFs can no longer stay afloat, many will move into hospital employment or larger health systems. That’s more consolidation, not less.

CMS has an opportunity to correct this with the 2027 Physician Fee Schedule. They should align SNFs under Place of Service 31 with nursing facilities under Place of Service 32.

Failing to do so is a threat to the health of our most vulnerable Missourians.