What the 2026 Medicare PFS “Efficiency Adjustment” Means for Primary Care — And Why Elation Signed On

For years, primary care physicians have watched the Medicare Physician Fee Schedule (PFS) quietly tilt against time-based care. Evaluation and management (E/M) visits have been systematically undervalued compared with many procedural services, even as primary care has become more complex and more central to better outcomes.

In late 2025, Elation Health joined a broad coalition of primary care advocates, health plans, and policy organizations in signing a letter to congressional leaders supporting the 2026 Medicare PFS Final Rule — specifically, its new “efficiency adjustment” policy. Here’s what that means for primary care practices and why it matters.

Rebalancing a System That Has Undervalued Primary Care

The PFS is budget-neutral: whenever payment for some codes goes up, others must come down. Over decades, that dynamic has eroded relative payment for primary care, behavioral health, and other time-based services, while many non-time-based services have not been updated to reflect real-world productivity gains.

The 2026 Final Rule takes a modest but important step to correct this:

• CMS introduces an efficiency adjustment targeting non-time-based services where technology and practice improvements have made care more efficient, but RVUs have not kept pace.

• To operationalize that, CMS applies a 2.5% reduction to intraservice time on selected services, using an economy-wide multifactor productivity measure as a proxy for actual efficiency gains.

Policy experts such as MedPAC and the National Academies have long argued that using productivity to recalibrate misvalued services is both reasonable and overdue. The sign-on letter Elation supported urges Congress not to delay, block, or weaken this adjustment.

Protecting Comprehensive, Relationship-Based Care

Crucially, CMS excludes E/M services from the efficiency adjustment. The signatories strongly support that choice, emphasizing that much of today’s primary care:

• Is more complex than in the past

• Requires longitudinal, patient-centered, team-based work

• Cannot simply be “made efficient” by cutting visit time without harming quality and trust

That’s why the letter frames the rule as a first step toward rebuilding a more empirically grounded, primary-care-supportive PFS, not a quick fix. It doesn’t solve every problem, but it begins to unwind distortions that have punished practices for doing the right thing — investing in comprehensive, coordinated care.

What Independent Primary Care Can Do Next

For independent primary care, pediatrics, and women’s health practices, this moment is a policy reset point:

• Lean into complexity. When payment policy starts to recognize the true work of comprehensive primary care, practices that double down on longitudinal relationships, care coordination, and behavioral health integration are best positioned to benefit.

• Show your value with data. As value-based contracts expand, documenting accurate risk, closing care gaps, and tracking outcomes become even more central to revenue and sustainability.

• Invest in workflow and technology. The efficiency adjustment assumes real productivity gains from better tools and team-based care. Practices that modernize workflows — for example, by using EHRs that reduce documentation burden instead of adding to it — can both improve margins and protect clinician wellbeing.

Elation signed the PFS letter because we believe payment policy should finally reflect what primary care has always been: the foundation of a high-performing health system, not an afterthought in a fee schedule.

Learn more about why Elation is the most trusted platform for primary care.