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By Matt Finkelstein
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A doctor’s appointment can begin exactly on time and still come far too late. For someone who needs medical care, an extra appointment can mean another absence from work, arranging a ride, and delaying an answer they are anxious to receive.
Those demands deserve consideration whenever policymakers decide what efficient care looks like. A lower payment on an insurance claim tells us little about whether the patient’s overall burden has improved.
That question belongs at the center of Medicare’s 2027 physician payment changes, finalized by the Centers for Medicare & Medicaid Services (CMS) in early November.
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The agency should assess what its rules may require of patients as it implements payment reductions for services that can appropriately be delivered together. Because commercial insurers may follow Medicare’s lead, these changes could extend well beyond Medicare patients.
Cost of Coordinated Care
CMS proposed reducing reimbursement when a separately identifiable office or outpatient evaluation occurs alongside certain procedures, performed that day by the same physician or another physician in the practice. The highest-priced service would receive full payment; the other affected services would receive 50 percent.
CMS argues that these encounters can involve overlapping resources and that existing payments may compensate practices twice for some work. That concern deserves a fair hearing. Public money should support necessary care, and physicians should be able to explain what distinguishes a separately billed evaluation from the work already covered by a procedure.
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But identifying possible overlap does not establish that every affected service should receive the same reduction. My concern is that a broad adjustment could make coordinating care less financially sustainable, even when coordination reduces the demands on patients.
That possibility warrants examination before the policy takes effect.
Consider a hypothetical patient who depends on a relative for transportation. An evaluation and a medically appropriate procedure completed together require one arrangement. Scheduling them separately could require a second request for help, another journey, and more time away from other responsibilities. The clinical work may be similar, while the household’s burden grows.
This is a potential consequence, not a prediction that every practice would separate visits. Physicians remain responsible for appropriate scheduling regardless of reimbursement.
Still, a payment policy should be tested for whether it makes the convenient, clinically sound option harder to provide. Good intentions alone cannot answer that question.
Measuring the Patient Burden
Research offers a way to recognize the burden. A report highlighted by the National Institutes of Health estimated that cancer patients’ time spent traveling, waiting, and receiving care represented $4.87 billion nationally in 2019. That historical estimate does not measure the proposed rule’s effects. It demonstrates that patients’ hours can be valued when assessing the cost of care.
Delay also deserves attention, although its implications vary by condition and treatment. A 2026 meta-analysis published in Annals of Surgical Oncology found that each additional 30-day wait before initial surgery for invasive breast cancer was associated with a 15 percent higher risk of death.
These findings do not establish that Medicare’s proposal would cause comparable harm, but they strengthen the case for considering timely access when evaluating payment changes.
As someone involved in running an oncology practice, I have an interest in how these payments are structured. That interest should come with accountability. Practices seeking adequate reimbursement should also demonstrate that their scheduling and coordination serve patients.
A useful assessment would track referral-to-appointment time, the interval before recommended treatment, and return visits that could safely have been avoided. Patient surveys could capture travel hours and difficulty arranging assistance.
Those measures should be considered alongside spending and clinical quality, with room for differences in patients’ needs.
Putting Patients First
Combining services should never become a target that overrides medical judgment or a patient’s preference. Some decisions require further testing, preparation, or time to consider alternatives. The goal should be to remove unnecessary visits while preserving every encounter that contributes to safe, appropriate care.
Before adopting the broad reduction, CMS should consider a different approach: reward practices that see patients quickly and safely accomplish more in one visit. In return, hold us accountable for faster access, fewer unnecessary visits, and quality that holds.
CMS should also evaluate the effects on scheduling and patient travel, then publish access measures so unintended consequences can be identified and corrected.
Practices should accept the same scrutiny by explaining avoidable return visits and improving coordination where possible. A credible efficiency policy would ask both payer and provider to account for the demands their decisions place on families.
Patients’ time should count before a saving is declared. We can reimburse an expense. We cannot give someone back a day.
Matt Finkelstein is the CEO of Southwest Women’s Oncology, Optimum Clinical Research, and the Optimum Human Performance Center in New Mexico. The views expressed in this article are the author’s own.
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