DR. JOEL BUNDY

October 28, 2025

Our nation’s health care system is under stress. Sadly, Virginia is not immune to the rising costs and strained health care workforce the rest of America is facing. The commonwealth ranks in the bottom half of states for physician availability, and by 2030, Virginia is projected to be short by nearly 4,000 doctors. This problem was exacerbated during the COVID-19 pandemic, which spurred physician burnout and resulted in critical staffin shortages.

This is making it challenging for Virginians to obtain primary care appointments, a particularly large concern for those who suffer from chronic disease or have complex health needs. In a state that is 88% rural, Virginians who live outside major cities are at serious risk. With fewer doctors available, patients often must wait longer for care and paymore out of pocket — costs that many simply can’t afford. Rural residents depend on community-based practices for their health care needs. These patients, many of whom live in under-resourced areas, are going to suffer the most if this trend continues.

Physician shortages are being amplified by shrinking Medicare payments. Even when adjusted for inflation, Medicare physician reimbursement has declined 33% since 2001, placing independent physicians in a dangerous position. Without reimbursement that keeps up with inflation, physicians are increasingly unable to expand their services, hire new staff, or take on new Medicare patients. This would put thousands of patients in Virginia at risk of losing access to local, timely, and affordable care.

Unable to keep up with the growing gap between reimbursement and rising costs, some doctors are even choosing to leave the Medicare program altogether. Primary care physicians have been exiting traditional Medicare at the highest rates, with 4.41% departing in 2023. Small practices, the pillars of Virginia’s rural communities, are especially vulnerable to the forces pushing physicians to exit.

The U.S., in short, needs long-term Medicare payment reform before it is too late. The latest Medicare Physician Fee Schedule (MPFS) proposed rule is a positive step in the right direction. Following a directive from Congress, Centers for Medicare and Medicaid Services (CMS) proposed a small increase in physician reimbursement next year.

During a recent hearing, our very own Rep. Morgan Griffith, of Virginia’s 9th District and chairman of the House Energy and Commerce Subcommittee on Health, said he wants to bolster the health care workforce and improve health care in rural communities. As a physician leader, I could not agree more. We encourage Congressman Griffith and all members on Congress to support long-term Medicare payment reform, so our physicians and our patients don’t have to suffer.

It’s time for Congress to pass long-term Medicare payment reform that ties annual reimbursement rates to inflation. From wages and rent to medical supplies and equipment, the cost of running a medical practice continues to rise. Yet Medicare payments to physicians have not kept pace. This mismatch threatens the viability of independent practices — especially here in Virginia — and could limit access to care for millions of Americans.

Dr. Joel Bundy was president of the Medical Society of Virginia 2024-2025.

Read article on Richmond-Times Dispatch here or on the Daily Progress here.

Richmond, Va. (Oct. 27, 2025) –The Medical Society of Virginia (MSV) Foundation announced the winners of their annual Salute to Service Awards at their Physicians Gala on Saturday, October 25, 2025. Seven Virginia physicians are being recognized from across the Commonwealth for their outstanding service in six categories: Service to — the Profession, the Uninsured and Underinsured, by an Early Career Physician, a Medical Student or Resident Advancing Patient Safety and Quality Improvement, and Distinguished Medical School Faculty Service Award.

The premiere award, Service to the Profession, has been given to Dr. Sterling N. Ransone, Jr., MD former president of the Medical Society of Virginia and the American Academy of Family Physicians.

The 2025 Winners of the MSV Foundation’s Salute to Service Awards include:

• Kaitlin Hardy, MD, Resident PGY1, Department of Pediatrics; Macon & Joan Brock Virginia Health Sciences, EVMS at Old Dominion University, Service by a Medical Student or Resident
• Megan Powers, MD, Emergency Medicine Residency; Macon & Joan Brock Virginia Health Sciences, EVMS at Old Dominion University, Service by a Medical Student or Resident
• Dimal D. Shah, MD of Richmond, Service by an Early Career Physician
• Laurie Archbald-Pannone of Charlottesville, Service for Advancing Patient Safety and Quality Improvement
• Joshua Easter, MD, MBA, MSc, MHA, of University of Virginia, Service by a Distinguished Medical School Faculty Member
• David E. Rapp, MD of Glen Allen, Service to the Uninsured and Underserved
• Sterling N. Ransone Jr., MD of Deltaville, Service to the Profession

The MSV Foundation created the annual Salute to Service Awards in 2004 to recognize outstanding efforts of physicians, residents, and medical students who are dedicated to creating and nurturing a caring health promotion and disease prevention environment by providing service on behalf of patients everywhere.

About the Medical Society of Virginia Foundation

The MSV Foundation (MSVF) advances opportunities for physicians to participate in health improvement efforts in Virginia by supporting programs and initiatives that equip physicians to best serve themselves, their patients and their communities. For more information, visit www.msv.org/foundation.

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year.

Your 2024 MIPS final score determines the MIPS payment adjustment you’ll receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026.

Access Your MIPS Payment Adjustment

• Sign in to the Quality Payment Program (QPP) website using the same credentials that allowed you to submit your 2024 MIPS data and check your 2024 MIPS final score. Refer to the QPP Access User Guide (ZIP, 4MB) for more information.
• Click “View Feedback” on the home page and select your organization (Practice, Alternative Payment Model (APM) Entity, Virtual Group).
  • Practice representatives can access individual, subgroup, and group performance feedback (final scores and payment adjustments).
  • APM Entity representatives can access APM Entity-level performance feedback (final scores and payment adjustments).
  • Virtual group representatives can access virtual group-level performance feedback (final scores and payment adjustments).
  • Third party representatives can’t access final feedback or payment adjustment information.
  • If you don’t have a HARP account or QPP role, please refer to the Register for a HARP Account (re: HARP account) and Connect to an Organization (re: QPP role) documents in the QPP Access User Guide (ZIP, 4MB) and start the process now.

Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Medicare Shared Savings Program ACOs are encouraged to identify at least one individual within your ACO who can obtain a HARP account with the Security Official role; additional individuals may request the Staff User role. ACO individuals can create and manage their HARP account and QPP access in the ACO Management System (ACO-MS).

Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at [email protected] or 1-888-734-6433 (Option 1).

• REMINDER: Representatives of Shared Savings Program ACO Participant Taxpayer Identification Numbers (TINs) and practices with clinicians receiving their APM Entity’s final score won’t be able to access the APM Entity’s performance feedback unless they’ve been granted the “staff user” QPP role for the APM Entity.

Payment Adjustment and Performance Feedback Resources:

• 2026 MIPS Payment Year Payment Adjustment User Guide (PDF, 2MB) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.
• 2024 MIPS Performance Feedback FAQs (PDF, 2MB) – Reviews the information available in performance feedback and how to access it. (We’re in the process of updating this resource with the Targeted Review deadline.)
• 2024 MIPS Performance Feedback Supplemental Reports Guide (PDF, 833KB) – Reviews the downloadable supplemental and patient-level reports for administrative claims quality and cost measures.
• 2024 Quality and Cost Benchmarks – Links to quality and cost measure benchmarks and supporting documentation. (Benchmarks determine measure scores.)

2024 Targeted Review Request Period Open Until November 14, 2025[1]

Beginning with the 2024 performance period/2026 MIPS payment year, the targeted review period closes 30 days following the release of MIPS payment adjustments (refer to 42 CFR 414.1385(a)(2)).

Who Can Request a Targeted Review?

Individual clinicians, groups, subgroups, virtual groups, APM Entities (including Shared Savings Program ACOs), designated support staff and authorized third party intermediaries may request that CMS review their MIPS final score and MIPS payment adjustment factor through a process called targeted review.

When to Request a Targeted Review

Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website. If you believe there’s an error in the calculation of your MIPS final score or MIPS payment adjustment factor, you can request a targeted review now until November 14, 2025, at 8 p.m. ET. Be advised that our ability to respond to inquiries and resolve requests will be delayed in most cases until normal government operations resume.

Examples of circumstances that could prompt a Targeted Review:

• Data were submitted under the wrong TIN or National Provider Identifier (NPI).
• You have Qualifying APM Participant (QP) status and shouldn’t receive a MIPS payment adjustment.
• Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.

Note: This isn’t a comprehensive list of circumstances.

How to Request a Targeted Review

To access your MIPS final score, performance feedback and request a targeted review:

• Sign in using your HARP credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2024 MIPS data and check your 2024 final score.
• Click “Targeted Review” on the left-hand navigation.

CMS may require documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact you about providing any specific documentation required.

• 2024 Targeted Review User Guide (PDF, 2MB) – Reviews the process for requesting a targeted review and examples for when you would or wouldn’t request a targeted review. (We’re in the process of updating this resource with the Targeted Review deadline.)

[1] Note: The federal government shutdown doesn’t affect your ability to submit a targeted review request by the above deadline, however it may affect our response time to resolve your request.

October 10, 2025

Vaccines are essential to the health of communities in Virginia. On October 6, 2025, the Centers for Disease Control and Prevention (CDC) made minor updates to its immunization schedules, including changes to recommendations for the MMRV (Measles, Mumps, Rubella & Varicella) and COVID-19 vaccines. These vaccines have been through rigorous testing and continuous evaluations and have been demonstrated as safe and effective. These vaccines also protect those
who are unable to be vaccinated.

COVID-19

• People aged 6 months and older can receive the COVID-19 vaccine based on individual- based decision-making with a healthcare provider, such as physicians, nurses and pharmacists.
• Individual-based decision-making allows for immunization coverage through all payment mechanisms, including entitlement programs; however, insurance coverage should be verified before vaccination. This includes programs such as Medicare, Medicaid, the Children’s Health Insurance Program, the Vaccines for Children (VFC) Program, and insurance plans regulated by the Affordable Care Act.
• Pharmacists can now administer COVID-19 vaccination without a prescription to persons aged 3 years and older, now that the CDC immunization schedule includes the 2025-26 COVID-19 vaccine. This is pursuant to the Public Readiness and Emergency Preparedness Act (PREP Act) for Medical Countermeasures Against COVID–19, 12th amendment.
• Pharmacies may have different policies about the ages of patients they will vaccinate. Encourage parents to verify the acceptable age of their local pharmacy before making appointments or visiting a pharmacy for vaccination.
• The Virginia Board of Pharmacy has updated its statewide protocol for adults effective October 1, 2025.
• With the CDC recommendations in place, the Virginia Commissioner’s Standing Order is no longer needed and has been revoked effective October 10, 2025.

MMRV (Measles, Mumps, Rubella & Varicella)

• MMRV vaccine remains FDA approved for children 12 months – 12 years.
• Children under the age of 4 years should receive the measles, mumps, and rubella vaccine and the varicella vaccine separately (MMR+V). The combined MMRV vaccine is no longer recommended for children under the age of 4 years.
• Children aged 4 years and older can still receive the combined MMRV vaccine. The recommendation for this age group has not changed.
• Per the VFC Provider Agreement, providers participating in the Vaccines for Children (VFC) program are required to comply with vaccine schedules, dosages, and contraindications established by the Advisory Committee on Immunization Practices (ACIP). As such, VFC providers can no longer give MMRV to children under the age of four years. Please see the VFC Provider Agreement for exceptions to this policy.
• If providing MMRV to a child younger than 4 years of age, insurance coverage should be verified before vaccination, as it may no longer be covered.

Additional Information

• It is strongly recommended that all Vaccines for Children (VFC) providers carry a minimal stock of COVID-19 vaccine to ensure access for this population, who may not have options to seek it elsewhere. If you have questions about the VFC program, please contact [email protected].
• Existing Vaccine Information Statements should be used until new ones are published by the CDC.
• All administered vaccines in Virginia must be reported to the VIIS within 7 days of administration.
• CDC’s updated recommendations differ from recommendations from professional medical organizations. This includes:
  o American Academy of Family Physicians
  o American Academy of Pediatrics
  o American College of Obstetricians and Gynecologists

Thank you for your partnership in keeping Virginians safe and healthy.

Sincerely,

Karen Shelton, MD

State Health Commissioner

via American Medical Association | September 26, 2025

The AMA has long called for Congress to enact legislation that would: (1) permanently allow Medicare patients in every geographic area, not just patients in rural areas, to receive telehealth services by waiving the geographic restrictions in current law; and (2) permanently allow Medicare patients to receive telehealth services in their homes instead of having to go to a medical facility to receive telehealth from a distant site. To date, however, Congress has passed legislation that only temporarily waives these requirements. Most recently, in March 2025 Congress extended these telehealth flexibilities for a six-month period that ends Sept. 30, 2025.

Physicians who provide telehealth services to Medicare patients should be aware that if Congress is not able to pass legislation before Oct. 1, 2025, that extends government funding, then the current Medicare telehealth flexibilities will lapse. This means that telehealth services would be limited to rural areas as they were before the COVID public health emergency and that patients would not be able to receive telehealth services in their homes. In addition, the ability to provide audio-only services to Medicare patients would lapse, as would the Acute Hospital Care at Home program.

In past government shutdowns, whenever Congress passed legislation to reopen the government, it made the funding and policies retroactive to the effective date of the shutdown. Physician practices may want to consider adjusting their patient schedules for telehealth services, however, as neither the likelihood nor the duration of a shutdown are known.