The presidents of ASTRO and ACRO join the VHV guys to provide expert analysis of CMS's newly released 2026 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) proposed rules. Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) join us one week after the July 2025 release to examine the implications for radiation oncology and procedural specialties.

Key Topics Covered:

• CMS's new "efficiency adjustment"—a 2.5% reduction to work RVUs for procedural services
• New treatment delivery codes and potential APC "crosswalk" issues in radiation oncology
• Budget neutrality's role in specialty medicine reimbursement competition
• The shift from survey-based valuations to hospital cost data methodology
• Practice expense changes affecting technical component payments
• RUC committee dynamics and specialty representation challenges
• 34-year evolution of the RVU system and its impact on different specialties

Critical Policy Analysis: The episode examines how CMS assigned new radiation therapy codes to ambulatory payment classifications, potentially using incorrect methodologies that may not account for IMRT services bundled into new level 2 and level 3 codes. Our expert guests explain why radiation oncology has experienced a 21% decline in relative value over two decades while primary care increased 38%.

About Our Guests: Dr. Sameer Keole serves as President of the American Society for Radiation Oncology (ASTRO) and is a practicing radiation oncologist in Arizona. Dr. Brian Lally is President of the American College of Radiation Oncology (ACRO) and practices at an academic center in South Carolina. Both bring extensive experience in healthcare policy and specialty society leadership.

This executive briefing provides physicians and healthcare leaders essential context for the 60-day comment period ending September 12, 2025, and explores strategies for effective advocacy during the rulemaking process.

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Episode Tags: Medicare physician fee schedule, MPFS, HOPPS, efficiency adjustment, radiation oncology, ASTRO, ACRO, CMS proposed rule, RUC committee, budget neutrality, APC methodology, conversion factor, practice expense, healthcare policy analysis, specialty medicine, procedural services