Efficiency Adjustment Delay Act
- Sponsor
- Rep. Estes, Ron [R-KS-4]
- Committees
- Ways and Means Committee (primary)
- Last action
- Feb 12, 2026
Bottom line
This bill provides a temporary financial boost to Medicare physicians by delaying a potential payment reduction and increasing a key payment factor for one year, while requiring further study on long-term efficiency adjustments.
What it actually does
This bill delays the implementation of a planned efficiency adjustment to work relative value units (RVUs) under the Medicare physician fee schedule until January 1, 2030. It also temporarily increases the update to the Medicare physician fee schedule conversion factors for calendar year 2026, reverting to original percentages in subsequent years. The bill mandates a report to Congress on the necessity of such efficiency adjustments and sets conditions for any future implementation.
Proponents argue
Supporters argue that this legislation is crucial for stabilizing physician payments amidst rising practice costs and inflation, preventing potential cuts that could jeopardize access to care for Medicare beneficiaries. The delay allows for a more thorough assessment of the efficiency adjustment's impact and greater stakeholder input, ensuring that any future changes are carefully considered.
Opponents contend
Critics contend that delaying necessary efficiency adjustments could perpetuate overpayments for certain services and hinder efforts to modernize the Medicare physician fee schedule, ultimately impacting the program's long-term fiscal sustainability. They may also argue that temporary payment increases add to Medicare costs without addressing underlying structural issues in physician reimbursement.
The bill is very short and focused, making it highly accessible for a quick review by an informed reader.
Section 2(a)
Delayed Implementation of Work RVU Efficiency Adjustment
This provision prohibits the Secretary of Health and Human Services from implementing a specific efficiency adjustment to work relative value units (RVUs) and related updates to physician time inputs, which were outlined in a November 2025 final rule, until January 1, 2030. It also requires the Secretary to submit a report to Congress within two years, assessing the necessity of a one-time, across-the-board adjustment to work RVUs for services not recently revalued. Future implementation of such an adjustment is subject to conditions, including consultation with physician specialties and restrictions on its application and methodology.
Supporters argue
Physician advocacy groups argue that this delay is essential to prevent significant payment cuts that could destabilize practices, particularly for services that have not undergone recent revaluation. They contend it allows for a more thorough analysis and stakeholder consultation, ensuring that any future adjustments are fair and do not compromise patient access to care.
Critics contend
Some health policy analysts and fiscal conservatives might argue that delaying necessary efficiency adjustments could lead to inefficient spending within Medicare and hinder efforts to modernize the fee schedule. They may contend that such delays perpetuate potentially misvalued services and postpone crucial reforms aimed at ensuring payment accuracy and program sustainability.
Tradeoffs
This provision navigates the tension between ensuring the financial viability of physician practices and maintaining patient access to care, against the need for Medicare to implement payment efficiencies and control costs for long-term fiscal sustainability.
Section 2(b)
Temporary Increase to Medicare Physician Fee Schedule Conversion Factors
This provision amends the Social Security Act to temporarily increase the update to the Medicare physician fee schedule conversion factors for calendar year 2026. Specifically, it changes the update for the qualifying Alternative Payment Model (APM) conversion factor from 0.75 percent to 1.24 percent, and for the nonqualifying APM conversion factor from 0.25 percent to 0.74 percent. For 2027 and all subsequent years, these updates revert to their original percentages of 0.75 percent and 0.25 percent, respectively.