March 23, 2026
McKnight's Long-Term Care News
A coalition of geriatricians and nursing home advocacy groups is raising “serious concern” about a new policy that pays doctors treating skilled nursing patients less than when they care for long-term care patients.
PALTmed and the American Geriatrics Society last week joined the nation’s two largest nursing home associations in calling on the Centers for Medicare & Medicaid Services to reverse new practice expense coding that risks discouraging clinicians from practicing in post-acute settings.
“Decreasing payments to practitioners who provide care in SNFs will discourage clinicians from continuing to work in or entering this setting, creating serious access concerns for nursing home residents,” the group told CMS in a March 16 letter. “This is not a theoretical concern; it is an immediate threat to access for some of Medicare’s most frail and vulnerable beneficiaries.”
As part of its final 2026 Medicare Physician Fee Schedule Final Rule, CMS instituted changes that sought to limit expense practices for some doctors. The cuts went into effect Jan. 1. But nursing home advocates argue that scaling back pay for those who round in nursing homes was a mistake because almost all of them are independent practitioners whose overhead costs are not covered by post-acute facilities or hospitals.
Hospital-based physicians might be better able to absorb such changes because they are typically employed by the hospital and do not pay for patient services expenses, the associations said. But nursing home practitioners receive no such institutional support.
“The practitioners providing care in SNFs and NFs are the same clinicians, using the same equipment, and bearing the same costs,” the letter stated.
The organizations noted that those costs range from providing bedside tools such as stethoscopers and sharp debridement equipment to laptops to their own Electronic Health Record systems, secure messaging platforms, coding and billing services necessary for Medicare compliance, malpractice coverage and more.
Payment meant to offset those overhead costs, however, now changes solely based on certification status.
“The reduction in [practice expense payments] is particularly concerning because post-acute SNF patients are among the most medically complex patients a clinician will encounter outside of the hospital,” the letter said. “These individuals are often transitioning directly from acute care hospitalizations and require more frequent clinical attention, adjustment of complicated medication regimens, interpretation of laboratory and imaging results, and close monitoring to identify early signs of deterioration and prevent rehospitalization.”
The groups asked CMS to remedy the cuts through immediate guidance or an interim final rule that exempts nursing home evaluation and management codes from a broader effort to limit practice expenses, and restores parity in codes for skilled and non-skilled nursing home care.
The agency did not respond to a McKnight’s request for comment by publication deadline Monday.
“Medicare beneficiaries in skilled nursing facilities deserve equitable access to clinician care,” PALTmed, AGS, American Health Care Association and LeadingAge said. “Payment policy should reflect the realities of care delivery and the true costs borne by practitioners.”