October 1, 2025

IMA Annual Meeting Around the Corner

The 133rd IMA Annual Meeting convenes in Sun Valley on Friday, October 10.

Delegates are reminded to download meeting materials, including resolutions and reports, before they arrive in Sun Valley.

Documents can be downloaded from the IMA website.

Don't forget to bring a laptop computer, tablet or smartphone, as voting will be conducted ONLY online through our meeting platform, Meeting Pulse.

More information on the Annual Meeting can be found here. We look forward to seeing you in Sun Valley!

IMA Urges Dept. of Health and Welfare to Reconsider 4% Cut to Medicaid Reimbursement

In a recent letter to the Idaho Department of Health and Welfare, IMA expressed serious concern and opposition to the 4% Medicaid provider rate reduction enacted September 1st.

IMA CEO Susie Keller noted: "With Idaho physicians already facing devastating cuts to Medicaid payments contained in HB 345 which terminates the Healthy Connections program, this rate reduction comes at the worst possible time...Ultimately these cuts will not just strain physician practices -- they will erode patient access to timely, local and high-quality healthcare across Idaho."

Medicaid insures more than 350,000 Idahoans, 42% of which are children. Idaho receives $2.9 billion in federal Medicaid funding, or 80% of total Medicaid spending in the state. Idaho Dept. of Health and Welfare Director Juliet Charron will be a guest speaker at IMA's upcoming Annual Meeting, providing an update on Medicaid and answering your questions. IMA appreciates Director Charron's engagement with the medical community as we work together to foster healthy communities throughout the state.

90+ Physician Organizations Urge Extension of Enhanced Premium Tax Credits

September 19, 2025

AMA Advocacy Update

The AMA, along with more than 90 national medical specialty societies and state medical associations, sent a joint letter to congressional leadership urging expansion of the enhanced advance premium tax credits (APTCs). These credits have helped more than 24 million Americans afford coverage through the Health Insurance Marketplace in 2025, including many older patients, those in rural areas, and small business owners.

Without congressional action, the consequences would be severe. The Congressional Budget Office estimates that 4.2 million people would lose coverage, and many would face steep premium hikes -- for example, $2,600 more annually for a family of four earning $64,000 and nearly $17,500 more for a 60-year-old couple earning $80,000. Even patients not receiving APTCs would be impacted as the expiration would destabilize the marketplace and drive overall premiums higher.

The letter highlights the importance of Congress acting in a way that gives patients, insurers and physicians certainty in advance of the 2026 coverage year. Extending the enhanced credits will help preserve affordability, sustain coverage levels and limit uncompensated care costs for physician practices nationwide. The AMA will continue to advocate strongly for this critical policy.

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Government Shutdown: What Physicians Need to Know

Excerpted from Oct. 1 email from AMA CEO and Executive Vice President John Whyte, MD, MPH

According to the Centers for Medicare & Medicaid Services (CMS) contingency plan, during a lapse in funding, the Medicare program will continue. CMS has sufficient funding for Medicaid to fund the first quarter of FY 2026, based on the advance appropriation provided for in the Full-Year Continuing Appropriations and Extensions Act, 2025. CMS is maintaining the staff necessary to make payments to eligible states for the Children's Health Insurance Program (CHIP). CMS is also continuing Federal Marketplace activities, such as eligibility verification, using Federal Marketplace user fee carryover. Other non-discretionary activities including Health Care Fraud and Abuse Control (HFAC) and Center for Medicare & Medicaid Innovation (CMMI) activities are also continuing.

During the shutdown, CMS expects slowdowns or suspensions of the following agency activities: (1) health care facility survey and certification, (2) policy development and rulemaking, (3) contract oversight, (4) outreach and education, and (5) beneficiary casework. CMS retains 53% of its staff to continue essential operations, while 47% of agency staff are being furloughed.

In the past, Congress generally has restored lapsed policies back to the effective date of the shutdown. During the shutdown the AMA is monitoring any potential delays in Medicare claims processing or other Medicare payment problems that could result from federal staffing reductions at CMS, including during the shutdown. Physicians and medical practice staff who experience Medicare payment delays or other obstacles that could be tied to reduced staffing levels at the agency or its Medicare Administrative Contractors (MACs) are asked to inform AMA advocacy staff of these problems by emailing ama.advocacy@ama-assn.org and including the subject heading "Medicare Payment Delay."

CMS Proposes Expansion of Evaluation & Management (E/M) Visit Complexity Add-On to Home and Residence Services

The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the use of the Evaluation & Management visit complexity add-on code, HCPCS code G2211, to include home and residence services. This builds on the CY 2024 Physician Fee Schedule final rule, which first established separate payment for G2211 when reported with office/outpatient E/M visits. The add-on code was intended to capture the inherent complexity of evaluation and management visits associated with medical care services that serve as the continuing focal point for all needed health care services that are part of ongoing care for a patient's single, serious, or complex condition.

A recent analysis by the American Medical Association (AMA) demonstrated that G2211 was highly underutilized compared with CMS's projections. In the review of the first three quarters of 2024 Medicare claims data, the AMA found that G2211 was reported in only 10.5% of office/outpatient E/M visits, far below CMS's estimate of 38%. If trends continued through the fourth quarter, the utilization was expected to rise slightly to about 11.2%, but still remain well under the original projection.

This discrepancy had significant financial and payment system implications. Because the code was implemented in a budget-neutral manner, the over-estimate in expected usage resulted in an overly large budget-neutrality adjustment to the Medicare conversion factor. The AMA estimates that the payment schedule reduction (2.18% in 2024) should have been only 0.79%, meaning physicians' payments were cut nearly three times more than warranted based on actual use of G2211. The AMA is urging CMS to adjust the 2026 conversion factor to correct the miscalculation.

As per the draft rule, CMS is proposing to allow HCPCS code G2211 to be billed as an add-on code with the home or residence evaluation and management visits code family (CPT codes 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350). The new code descriptor would read as follows:

• Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (Add-on code, list separately in addition to home or residence or office/outpatient evaluation and management service, new or established.

If finalized, this expansion would ensure the complexity of care provided in patients' homes and residences is acknowledged and fairly compensated. Combined with correcting the underutilization estimates, the proposal signals CMS's intent to align payment more closely with the actual practice realities of longitudinal, home-based, and complex care.

Family/Internal/Sports Medicine Provider for Pioneering Health Center

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• Deliver preventive and primary care, spanning in-depth, duty-specific Annual Wellness Exams; leading-edge cardiac and cancer screenings; occupational/sports medicine; and broad-spectrum family medicine care.

• Collaborate with physical therapy, exercise physiology, mental health, massage therapy, and acupuncture professionals in dynamic, multi-disciplinary outpatient setting.

About Emergency Responders Health Center: Safeguard the lives of those who safeguard our local communities, with ERHC. Established in Boise in 2004, ERHC is regarded as our region's leader in first responder medicine. ERHC is the provider of choice for nearly 40 fire, law enforcement, and paramedic departments, and cares for a patient panel of more than 8,000 responders and their spouses and dependents. ERHC's practice model spans "360 degrees of care" from preventative health and wellness, occupational medicine, primary and urgent care, physical therapy and Workers' Compensation case management, to mental health services and workforce wellness consultation. Based on continued growth ERHC has opened a second southwestern Idaho clinic in Nampa, increasing convenience for patients across the Treasure Valley.

For more information, visit https://er-hc.org/careers.