Filibusters & Fine Print

Everyone in Washington is talking affordability, but CMS leadership has a different word for it: deflationary. The team gets raw (yes, there’s an Eddie Murphy reference) on who actually pays when Medicare decides it can get the same lab test, scan, or office visit cheaper somewhere else. The team discusses the preliminary 2027 lab fee schedule, a provision requiring every off-campus hospital department to get its own NPI, and why that data may power the next round of site-neutral cuts.

It’s Libra Season, the gang is all together, and we’re here to discuss the most pertinent issue of the moment: Lauren (aka Diva 1) and her birthday adventure. In less important news, the gang also tackles the upcoming midterm elections, cutting through the campaign noise to unpack what the 2026 election could mean for AMGA members through the end of the year—and how they should prepare. Then it’s on to the December lame-duck session: telehealth extensions, physician payment reform, must-pass legislation, potential offsets, and the perennial question: What can Congress actually get across the finish line before the year ends? Finally, we look beyond the lame duck to the next Congress, covering Medicaid and ACA coverage, Medicare Advantage, drug pricing, 340B, prior authorization, consolidation, and more—and give AMGA members practical steps to prepare for what’s coming.

Buried in the Physician Fee Schedule is a proposal that could cut Medicare payments in half for millions of same-day office visits. Changes to Modifier -25 would cut same-day services in half for whichever of those two services is worth less, framed as an "efficiency" adjustment — and CMS admits it'll be watching for practices that reschedule visits to get around it. In this episode, the AMGA team breaks down the what’s happening with same-day services, why CMS says this is really about pushing patients toward primary care, and what happened when AMGA sat down with CMS leadership, the White House Domestic Policy Council, and a Senate office to make the case against it.

The public policy legislative team is back to discuss Congress’s return to session and its abrupt departure. Expect sidebar conversations discussing astrology, the use of therapy-speech, and why members of Congress needed to return to the campaign trail posthaste. Additional details and all episodes are available on the AMGA website.

Medicaid Managed Care State Directed Payments Rule

Our trilogy closes where a lot of state Medicaid financing quietly lives: state directed payments. CMS wants to swap the current commercial-rate benchmark for a Medicare-based one — and extend it further than the law technically requires. We close out the series with the $500-billion question of who absorbs the cut when the financing rug gets pulled.

CY2027 OPPS/ASC Proposed Rule The sequel nobody asked for but everybody needs to understand: CMS wants to slash 340B drug payments by a third, speed up an old remedy clawback, and keep pushing more procedures out of hospitals and into lower-cost sites of care. A "routine" 2.4% headline number hides one of the more consequential outpatient rules in years. In part two of the trilogy, we go under the hood on the fights that'll actually move the needle for hospitals and health systems.

CY2027 Physician Fee Schedule

Every summer, CMS drops a rule that decides how much your practice gets paid—and this year's chapter has a twist nobody wanted: The conversion factor is falling even though the statutory update is technically positive. We break down the math behind the drop, the launch of the first mandatory specialist accountability model in Medicare history, and what it all means for the physicians actually billing these codes. This is Chapter 1 of our three-part dive into the rules reshaping 2027. Additional details and all episodes are available on the AMGA website.

AMGA's public policy team runs through Capitol Hill happenings as rising healthcare costs and consolidation draw more attention from Congress and the Trump Administration. This episode covers current financial pressures on providers, including H.R. 1 Medicaid implementation, Medicare reimbursement, site-neutral payment proposals, and increased oversight. It also dives into other Congressional focus areas such as physician payment reform, rural workforce issues, and price transparency.

Fresh off Capitol Hill Day 2026, the AMGA policy team sits down to unpack the event with candid takeaways on how conversations with lawmakers have shifted this year. The team breaks down the issues dominating discussions, key bills moving through Congress, and what policymakers and their staff are asking for: real numbers, real stories, and the real impact on practices.

Lauren and Darryl unpack one of the more consequential conversations AMGA has had in recent memory: CMMI Director Abe Sutton's meeting with AMGA's Board of Directors. Darryl breaks down Sutton's priorities — a push for downside risk, longer and more stable model designs like the new LEAD model, and a genuine interest in using AI as a workforce extender in the face of a looming clinician shortage. Lauren draws the comparison to Adam Boehler's tenure and asks what's really different this time. The bottom line: Sutton heard AMGA's years of feedback on predictability and stability, and he said so directly. Now it's on AMGA and its members to show up, share what's working, and help shape what comes next — because as Lauren puts it, Sutton appears to be “willing and able” to do exactly that.