Highlights from the 2026 AMA Annual Meeting: Moral distress widespread, distinct from burnout

How resolving moral distress unlocks physicians’ potential

Burnout has become one of the defining conversations in medicine, as it should be. The pressures facing physicians and medical students are real, growing and impossible to ignore. But burnout is not the whole story.

Across medicine, many physicians are confronting something deeper: moral distress. New research shows it is widespread, distinct from burnout, and carries serious consequences for physicians, patients and the healthcare system itself. Read more.

AMA: No, physicians are not “providers”

Navigating the healthcare system is a challenge for many patients, and one reason is the system’s persistent use of confusing terminology around who is a physician. At its Annual Meeting in Chicago this week, the House of Delegates (HOD) acted to eliminate this confusion—and thereby boost patient safety—by deliberately avoiding use of the term “provider” when referring to any clinician with a medical degree.

The AMA already had policy stating that it supports requiring healthcare entities, when using the term “provider” in contracts, advertising and other communications, to specify the type of clinician being referred to by using the clinician’s recognized title, which details their education, training, license status and other recognized qualifications. The policy also supports this concept in state and federal health system reform. Read more.

More in Highlights from the 2026 AMA Annual Meeting:

[Article] New AMA president: Courageous leadership can reshape healthcare
[Article] Outgoing AMA president: Physicians must unite, lead with purpose
[Article] AMA CEO: Putting doctors back at center of the healthcare conversation

What doctors want patients to know about injectable peptides

Interest in injectable peptides is rising as more people see them promoted online through health and wellness influencers for weight loss, muscle growth, recovery and anti-aging. But behind the buzz is a more important question: Are these products safe, effective and backed by evidence?

Physicians say patients should look past social media claims and marketing promises and start with a conversation with a doctor because some injectable peptides are not regulated and may carry real health risks. Read more.

More in Public Health:

[Article] What VO2 max is and why your score could be important to know
[Article] What doctors want patients to know about pancreatic cancer
[Reader Favorite] 9 things patients should know about taking creatine

How independent physicians are making it work

Dr. Mollie James was embarrassed when her functional medicine practice filed for bankruptcy in 2019. She felt like a complete failure.

“I thought it was the worst thing that could happen,” James said. “I’m the ‘A’ student, the valedictorian, all those things. I didn’t want anybody to know. ”

Fast-forward seven years, and James is the owner of a multimillion-dollar concierge practice with two locations in Iowa, a third in Missouri and a fourth slated to open in Texas later this year. She also offers virtual care services.

Owning an independent practice is a daunting prospect financially. Physicians invest their savings and retirement accounts into a practice or take out business loans, but they often lack the know-how to operate a successful business. Clinics typically take years to become profitable, which may not be aviable option for doctors saddled with student loan debt.

Joining a large system or physician group that handles back-office operations and offers a steady paycheck is the easier path. However, some physicians say there is still a place for independentmedicine, despite the challenges.

Here’s what four practices have done to make it work.

Start small

James’ second act, James Clinic, launched in 2021 to treat a range of conditions through integrative medicine, including cancer, neuropathy and hormonal imbalances. It serves about 1,500 to 2,000 patients each year.

James decided to avoid past missteps and start small after the bankruptcy.

Her former practice struggled with high overhead costs. This time around, her first office in Chariton, Iowa, rented for $400 per month. James also transitioned to a self-pay model.

Branding was another hurdle to overcome. James said she developed a marketing strategy that focuses on patient needs, rather than selling products.

James wants others to avoid her mistakes. Later this year, James is launching Maverick Medical Ventures, which will support physicians who want to leave a health system and build their own practice.

Find additional income

Dr. Steve Furr, co-owner of Family Medical Clinic in Jackson, Alabama, has practiced independently for decades. His practice, which includes two other physicians and three nurse practitioners, is a designated rural health clinic.

Several years ago, the clinic launched a chronic care management program. Staff members regularly check in on patients to see if they are staying on their medications, need referrals or have any changes to report since their last appointment. Furr said the program brings in additional income and helps the clinic stay connected with patients.

Running a practice requires tough decisions, he said. Owners must assess whether patient volumes will support investments in new equipment, technology or services. In general, an investment only makes sense if the practice can at least break even on it, he said.

“As things have gotten tighter and tighter over time, you just can’t have things in your practice that you lose money on,” Furr said. “You do like any other business. You try and look and see where you can cut costs, where you can lower your overhead to try and maximize your income.”

Connect with other physicians

Dr. Stacey Bartell, owner of iTest Health Family Medicine in Livonia, Michigan, needed a change after the COVID-19 pandemic. She left a local health system in 2022 to start her practice. A decade-long stint as a medical director at a former employer meant she understood the business side of medicine.

Bartell said one of her biggest challenges is getting paid — ensuring the right codes are submitted to insurers and following up on claims denials and prior authorizations. Her practice, which serves nearly 1,500 patients, is starting to see people drop Medicaid coverage.

“There are days where I just run out of energy, ” she said. “We’re doing the best we can.” Bartell said it is helpful to collaborate with other private physicians and share resources when payment challenges arise.

Keep it lean

Dr. David Schechter built his family and sports medicine practice incrementally — developing a patient panel part time while working at other practices and teaching a residency program. He went full-time as an independent physician in 2002.

Schechter has a lean operating model. He is the sole clinician at the Los Angeles-area practice. There is one front-office employee and another employee, often a gap-year student, who takes vital signs and helps with other clinical tasks. Billing is outsourced. The practice’s expense ratio hovers at 35% to 40%, he said.

“My whole philosophy has been easing your way into private practice rather than necessarily jumping in, ” Schechter said. Schechter also specializes in chronic pain management through mind-body medicine, which attracts more patients and sets him apart from other primary care practices.

He also has reduced the number of insurance contracts and moved toward self-pay. For the remaining contracts, the practice is part of an independent physician association, which brings physicians together to increase bargaining power and secure higher reimbursement rates.

Read full article with subscription at Modern Healthcare

Virginia’s Amended Reporting Requirements and Penalties: What Hospitals, Health Systems, and Health Care Providers Need to Know About the 2026 Amendments to Va. Code § 63.2-1509

The Virginia General Assembly has enacted significant amendments to Virginia’s mandatory child abuse and neglect reporting statute, Va. Code § 63.2-1509, effective July 1, 2026 (2026 Va. Acts ch. 845). The amendments tighten timelines, strengthen penalties, and impose heightened criminal liability on institutional actors — including hospitals and other facilities providing care and treatment to children – and mandatory reporters who fail to timely report suspected child abuse or neglect within 24 hours. Health care providers, hospital administrators, and compliance officers should review and update their reporting policies and training programs immediately, as appropriate, to ensure all covered employees are aware of the new requirements and penalties.

Existing Hospital Reporting Requirements for Health Professionals

For many years, Virginia law has required the Chief Executive Officer and Chief of Staff of every hospital or other health care institution in the Commonwealth to report to the Director of the Department of Health Professions (“DHP”) certain information about licensed, certified, or registered health professionals, multistate nursing privilege holders, and applicants. The primary reporting statute is summarized below; note that additional statutory reporting requirements also exist. See, e.g., Virginia Code 54.1-2909.

Va. Code § 54.1-2400.6: Key Hospital Reporting Requirements

Hospitals are required to report to the DHP the following concerns regarding professional conduct, impairment, and disciplinary matters:

  • Five-day window for reporting for certain admissions: Report within five days after learning of a health professional’s involuntary admission for treatment of substance abuse or psychiatric illness. A report is also required after the 30-day period following a voluntary admission for substance abuse or psychiatric illness, unless the treating physician, physician assistant, or nurse practitioner provides written confirmation that the professional is no longer believed to be a danger to self, the public, or patients.
  • Thirty-day window for reporting reasonable-belief determinations: Report within 30 days after the CEO, chief of staff, director, or administrator determines, after appropriate review, investigation, or consultation with internal boards or committees, that there is a reasonable belief the health professional may have engaged in unethical, fraudulent, or unprofessional conduct.
  • Thirty-day window for reporting certain disciplinary proceedings: Report within 30 days after written notice to the health professional that the institution has begun a disciplinary proceeding involving intentional or negligent conduct causing or likely to cause patient injury, professional ethics, professional incompetence, moral turpitude, or substance abuse.
  • Thirty-day window for reporting specified disciplinary actions: Report within 30 days after written notice of disciplinary action taken during or at the conclusion of proceedings, or while under investigation, including denial or termination of employment, denial or termination of privileges, or restriction of privileges resulting from the specified categories of conduct.
  • Reports for resignations or privilege restrictions while under review: Report voluntary resignation from staff, voluntary restriction of privileges, or expiration of privileges while the health professional is under investigation or subject to disciplinary proceedings for matters related to patient injury risk, medical incompetence, unprofessional conduct, moral turpitude, mental or physical impairment, or substance abuse.

Required report contents and Immunity

Reports must be in writing and include the subject professional’s name, address, and date of birth; a full description of the circumstances; the names and contact information of individuals with knowledge and of individuals consulted to substantiate the facts; relevant medical records when patient care or the professional’s health status is at issue; and notice if the hospital has submitted an NPDB report. The health professional must be provided a copy of the report. Good-faith reporters and participants in related investigations or proceedings receive civil immunity absent bad faith or malicious intent. However, immunity is a defense that must be proven, and it does not bar a lawsuit from being filed. Failure to make a required report may result in a civil penalty of up to $25,000 and may affect licensure, certification, or renewal until the penalty is paid.

Peer review privilege preserved

Compliance with the reporting statute does not waive or limit Virginia’s peer review privilege under Va. Code § 8.01-581.17. The privilege does not bar required reports or requested medical records necessary to investigate reportable unprofessional conduct but privileged materials may be withheld. Hospitals and health systems should confirm that their practitioner health, medical staff, credentialing, peer review, human resources, and compliance processes identify when a matter triggers reporting under Va. Code § 54.1-2400.6 and other reporting statutes, in addition to the child abuse reporting requirements addressed in this advisory. Written policies should be updated to reflect the amendments to the revised child abuse reporting requirements outlined below.

ACTION REQUIRED: Review and understand the amendments to Virginia Code § 63.2-1509.In the new subsection F, a required reporter (identified in subsection A) must report suspected child abuse or neglect within 24 hours of having reason to suspect a reportable offense. Under the new subsection C, a reason for suspicion includes any suspected violation of §§ 18.2-370 through 18.2-370.6 or § 18.2-374.3 involving a child. The statute’s requirements are further summarized below.

1.  “Who is required to report suspected child abuse or neglect in Virginia?”

Overview: A Broad Mandatory Reporting Framework

Virginia’s mandatory reporting statute, Va. Code § 63.2-1509, requires a wide range of professionals who, in their professional or official capacity, have reason to suspect a child is abused or neglected to report immediately to the local department of social services or to the Department’s toll-free child abuse and neglect hotline. The list of mandatory reporters is extensive and includes:

  • Any person licensed to practice medicine or any of the healing arts
  • Any hospital resident or intern, and any person employed in the nursing profession
  • Any person employed as a social worker or family-services specialist
  • Any mental health professional
  • Any professional staff person employed by a private or state-operated hospital, institution, or facility to which children have been placed for care and treatment or committed
  • Any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody, or control of children
  • Emergency medical services providers certified by the Board of Health
  • Any person who engages in the practice of behavior analysis, as defined in § 54.1-2900

This is not an exhaustive list. For health care institutions, virtually all clinical and support staff with patient contact — including physicians, nurses, therapists, social workers, and EMS personnel — may be mandatory reporters under Virginia law.

2.  “What triggers a reporting obligation?”

Standard: Reason to Suspect

A reporting obligation arises when a covered professional has “reason to suspect” a child is abused or neglected. The current statute defines this standard as extending to three clinical scenarios:

  • Substance-affected newborns: A health care provider finding within six weeks of birth that the child was born affected by substance abuse or experiencing withdrawal symptoms from in utero drug exposure.
  • Substance-related diagnoses: A diagnosis made within four years of birth that the child has an illness, disease, or condition attributable to maternal abuse of a controlled substance during pregnancy.
  • Fetal Alcohol Spectrum Disorders: A diagnosis made within four years of birth that the child has a fetal alcohol spectrum disorder attributable to in utero alcohol exposure.

When “reason to suspect” is based on one of these clinical findings, that fact must be included in the report. Critically, such reports do not constitute a per se finding of child abuse or neglect.

The amended statute has expanded the definition of a “reason to suspect that a child is an abused or neglected child” to include any suspected violation of the offenses defined in Va. Code §§ 18.2-370 through 18.2-370.6 or § 18.2-374.3 involving a child.[1]

3.  “How quickly must a report be made?”

The 24-Hour Reporting Deadline

Reports must be made as soon as possible, and not later than 24 hours after the covered professional has reason to suspect a reportable offense. A report not made within 24 hours may create compliance risk if the delay cannot be shown to be reasonable under the circumstances. The initial report may be oral but must be reduced to writing by the child abuse coordinator of the local department on a form prescribed by the Board of Social Services.

For employees of hospitals or similar institutions, a covered employee may, in lieu of making a direct report, immediately notify the person in charge of the institution or a designated person in charge, who must then make the report “forthwith.” If this internal notification route is used, the person in charge must:

  • Notify the original reporter when the report is made to the local department or the hotline
  • Provide the name of the individual who received the report
  • Forward any resulting communications, including information about actions taken, to the original reporter

All mandatory reporters who maintain records on the child must cooperate with investigating agencies and make related records available, subject to applicable federal law (including FERPA). Health care providers’ provision of such records is not prohibited by Virginia’s privacy statute in Va. Code § 8.01-399.

4.  “What are the penalties for failing to report — and what changed in 2026?”

New Rule: Significantly Strengthened Criminal Penalties

The 2026 amendments added new penalty provisions to Va. Code § 63.2-1509 specifically targeting hospitals and similar facilities. The penalty structure is now as follows:

General Failures to Report (Subsection D/E):

  • First failure to timely report: civil fine of not more than $500
  • Subsequent failures: civil fine of not less than $1,000
  • Knowing and intentional failure where the reportable offense involves rape, sodomy, aggravated sexual battery, or object sexual penetration: Class 1 misdemeanor

NEW — Potential Healthcare Institutional Criminal Liability (New Subsection F): New subsection F, arguably the most significant addition to the statute, imposes heightened criminal liability specifically where the alleged abuse or neglect occurred at a private or state-operated hospital, institution, or facility to which children have been committed or placed for care and treatment as follows:

  • Failure to report as soon as possible and not longer than 24 hours after having reason to suspect a reportable offense: Class 1 misdemeanor (punishable by up to 12 months in jail and/or a $2,500 fine)
  • Second or subsequent conviction under this subsection: Class 6 felony (punishable by 1–5 years in prison, or up to 12 months in jail and/or a $2,500 fine at the court’s discretion)

This is a material escalation from prior law. Hospitals and other covered facilities should treat any employee’s failure to file a timely report as a potential criminal matter warranting immediate review by legal counsel.

5.  “Are there protections for good-faith reporters?”

Immunity for Good-Faith Reports

Virginia law provides broad immunity for mandatory reporters. Under Va. Code § 63.2-1509(D) — renumbered in the 2026 amendments but preserved— any person who:

  • makes a report or provides records or information pursuant to the statute, or
  • testifies in any judicial proceeding arising from such report, records, or information

shall be immune from any civil or criminal liability or administrative penalty or sanction on account of such report, records, information, or testimony, unless the person acted in bad faith or with malicious purpose.

This immunity should be communicated clearly to all mandatory reporters within an institution to encourage timely and complete reporting.

6.  “Are there any exceptions to the reporting obligation?”

Limited Exception: Actual Knowledge of Prior Report

Under the statute, no person is required to make a report if the person has actual knowledge that the same matter has already been reported to the local department or the Department’s toll-free child abuse and neglect hotline.[2] This exception is narrow: constructive knowledge or a general belief that someone else “likely reported” is insufficient. Institutions should not rely on this exception unless they can confirm that a specific, prior report has actually been filed.

Hospital and Health System Action Items

  • Immediately review and update internal mandatory reporting policies to reflect the new institutional penalty provisions (new Subsection F) and 24-hour deadline.
  • Train all clinical and administrative staff on who is a mandatory reporter, what triggers a reporting obligation, and how to make and document a report.
  • Designate and confirm reporting contacts (persons in charge or their designees) and ensure those individuals understand their obligation to report forthwith and notify the original reporter.
  • Educate staff of the broad immunity protection for good-faith reports.
  • Review any policies that might delay or discourage reporting and revise as appropriate to reduce potential criminal exposure for reporting delays.

Consult legal counsel immediately if a reporting failure is discovered at your institution, given the new Class 1 misdemeanor and Class 6 felony exposure.

References

[1] Va. Code § 63.2-1509(C), as amended by 2026 Va. Acts ch. 845 (H.B. 1414).
[2] Va. Code § 63.2-1509(G) (formerly subsection E), as amended by 2026 Va. Acts ch. 845.

For questions about this advisory, please contact the Hancock Daniel & Johnson, LLC team at (804) 967-9604 or visit hancockdaniel.com.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson LLC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson LLC be liable for any direct, indirect, or consequential damages resulting from the use of this material.

Additional Accredited Cannabis Training Now Available for Virginia Practitioners

The Virginia Cannabis Control Authority (CCA) is pleased to share additional accredited online training courses on medical cannabis now available for healthcare practitioners. 

In response to continued interest from practitioners, the CCA has expanded its partnership with TheAnswerPage.com to offer more optional, self-paced courses that support informed, evidence-based patient care. 

New courses include: 

Cannabis Use Disorder and Cannabinoid Hyperemesis Syndrome

This course provides evidence-based guidance on cannabis use disorder and cannabinoid hyperemesis syndrome. It covers clinical presentation, diagnostic criteria, screening tools, cannabis withdrawal, treatment strategies, and management of recurrent nausea and vomiting. Key concepts are reinforced through clinically relevant case scenarios. 

Cannabis and Cannabinoids in Clinical Practice

This course offers a clear, evidence-based foundation to help clinicians counsel patients on cannabis use, evaluate therapeutic applications, and recognize potential risks. Topics include how cannabinoids work in the body, cannabinoid pharmacology, clinical effects, risks and contraindications, and cannabis-related disorders. 

These new courses are in addition to the Virginia Medical Cannabis Program course bundle. All courses offer CME/CE credits and are designed for physicians, nurses, nurse practitioners, pharmacists, and dentists. 

These trainings may be useful for all practitioners, not only those who issue medical cannabis certifications, as more patients are using cannabis products and seeking guidance from their providers. 

Practitioners who choose to enroll can use the code VACANNABIS20 for 20% off at checkout. 

You can learn more and register through the CCA website. 

Measles Outbreak in Buckingham County

Dear Colleague:

The Virginia Department of Health (VDH) is announcing a measles outbreak in Buckingham County. As of May 13, VDH has identified twelve (12) outbreak-associated measles cases in the area. No patients reported recent travel. Without travel, the timing of these cases suggests local transmission. There are likely more measles cases than have been reported. In response, VDH is sharing important reminders and encouraging vaccination.

Vaccination Recommendations

The MMR vaccine is the best protection against measles. Please encourage your patients to be up to date with the routinely recommended number of MMR vaccinations.

Additionally, in the context of this outbreak, VDH encourages healthcare providers to talk to their patients who live in or visit the Buckingham County area about the following outbreak vaccination recommendations:

  • Infants aged 6 to 11 months are advised to get an early dose of the MMR vaccine. Infants who receive an early dose of MMR vaccine before their first birthday should receive two more doses at the recommended ages at least 28 days apart.
  • Children aged 12 months to 18 years old who have not yet been vaccinated or never had measles infection should receive their first MMR vaccine dose with a second dose at least 28 days after the first dose.
  • Children aged 12 months or older who have previously received only one MMR dose should receive a second MMR vaccine dose at least 28 days after the first dose.
  • Adults born after 1957 who have not previously been vaccinated or never had measles infection should receive at least one dose of MMR vaccine. Adults in the following groups should receive two doses of MMR at least 28 days apart:
    • Attend school beyond high school (e.g. college, trade school).
    • Work or volunteer in a healthcare facility of any type.
    • Travel internationally, including on cruise ships.
    • Family or close contact of people with compromised immune systems.
    • People with HIV infection without severe immunosuppression.A small number (<5%) of adults vaccinated between 1963 1967 received an inactivated (killed) measles vaccine. Adults who received this type of vaccine, or do not know what type of vaccine they received between 1963–1967, should receive 1 or 2 doses of MMR vaccine.

Free or low-cost vaccines are available through Virginia’s Vaccines for Children (VFC) and Vaccines for Adults (VFA) programs for those who are eligible. If needed, you can locate a VFC or VFA provider on the VDH Website.

Measles Testing and Reporting

All Virginia healthcare providers should consult the updated VDH’s Measles Reporting and Testing Algorithm for suspected measles cases. Consider measles in patients with a fever and generalized maculopapular rash who:

  • were potentially exposed to a person with measles-like illness; OR
  • reside in Buckingham County or surrounding areas; OR
  • who have recently traveled out of the country or to regions of the United States reporting measles outbreaks.

Providers practicing in and around Buckingham County should maintain a high index of suspicion for measles and test any patient presenting with measles-compatible symptoms. This outbreak is also a good reminder to check the immune status of the healthcare providers on your teams.

If you suspect measles:

  • Isolate: Immediately isolate the patient in a single-patient airborne infection isolation room (AIIR), or in a private room with a closed door until an AIIR is available.
  • Notify: Immediately notify your local health department to ensure rapid testing and investigation.
  • Test: Submit a nasopharyngeal (NP) swab in viral transport media or universal transport media for PCR testing and a serum specimen for testing at the Division of Consolidated Laboratory Services (DCLS). Follow instructions for specimen collection and handling. Test results are available in less than 24 hours.
  • Identify: Begin identifying staff, patients, and visitors who might have been exposed to the patient. If measles is confirmed, exposed people will need to be contacted and assessed for immunity.

Visit VDH’s Measles Information for Healthcare Providers for additional measles resources.

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

Sincerely,

B. Cameron Webb, MD, JD

State Health Commissioner

Data-Driven Performance Payment System (DPPS): Solving the Problems with the Merit-based Incentive Payment System (MIPS)

MIPS Background

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 consolidated three historic quality reporting programs into MIPS. MIPS requires physicians to report on quality measures, health IT measures, and improvement activities, creating significant administrative burden. The Centers for Medicare & Medicaid Services (CMS) also calculates cost measures and a new population health category (not-statutorily required) using claims data. CMS combines all of this data and generates a score of 0-100 points. Based on how their score compares to the national benchmark, physicians will see a penalty, a neutral payment adjustment, or a bonus. MIPS adjusts Medicare physician payment for all physicians unless they’re new to Medicare, qualifying alternative payment model participants, or have a low volume of Medicare patients or payments. The program is budget neutral. Penalties of up to -9 percent fund the bonuses.

Why are reforms to MIPS necessary?

  • MIPS disproportionately penalizes small and rural practices. Nearly 50 percent of solo eligible clinicians (ECs), 29 percent of small practices, and 18 percent of rural practices received a MIPS penalty in 2025 compared to fewer than 14 percent of ECs overall. Nearly 30 percent of solo ECs and 13 percent of small practices received the maximum -9 percent penalty compared to 2 percent of ECs overall.
  • MIPS is burdensome and costly. MIPS compliance costs $12,800 and requires 202 hours per physician per year according to a 2021 Journal of the American Medical Association(JAMA) Health Forum study.
  • MIPS does not measure quality and exacerbates health inequities. According to a 2022 JAMA study, MIPS scores are approximately as effective as chance in terms of identifying high versus low quality performance. Researchers found physicians providing high quality care but with low MIPS scores tended to have practices catering to a greater number of sicker and lower-income patients.
  • There are too few clinically relevant measures for specialists. MIPS scoring rules also disincentivize reporting on certain quality measures that are tailored to specialty care.

Introducing DPPS

It has been more than 10 years since MACRA passed, and change is urgently needed to reduce the harmful effects of MIPS. Designed as an alternative to MIPS, DPPS has been endorsed by the AMA, every state medical society, and more than 100 national specialty societies. DPPS would reset Medicare’s approach to improving quality and reducing avoidable costs by supporting small, rural and safety net practices; and increasing the clinical relevance of quality and cost measures to physicians and patients.

How does DPPS support small, rural, and safety net practices by reducing steep penalties?

  • DPPS would eliminate the win-lose tournament model and reduce the maximum penalty from -9 percent to one-half of a physician’s annual payment update (for example, 0.25 percent under current law or the increase in the Medicare Economic Index if H.R. 2474 passes), which is similar to other Medicare programs such as the Hospital Inpatient Quality Reporting Program.
  • It would reinvest penalties in quality improvement and alternative payment model readiness by assisting under-resourced practices with their value-based care transformation.
  • DPPS would freeze the performance threshold at 75 points for at least three years.

How does DPPS improve the clinical relevance and accuracy of cost and quality measures for physicians

and patients?

  • DPPS would incentivize CMS to fulfill its statutory obligations to share data on a quarterly basis, enabling physicians to improve performance on quality and cost measures.
  • Specifically, physicians who receive fewer than three MIPS performance feedback reports during the performance period would be exempt from any MIPS penalties.
  • With quarterly reports about which cost measures are being attributed to them, which patients are being assigned to them, and what costs outside of their practice they are being held accountable for, physicians can leverage this data to implement changes that would improve patient care and use resources more efficiently, saving money for the Medicare program, taxpayers, and beneficiaries.


DPPS would lower MIPS penalties and level the playing field
With insights from the 2023 MIPS Experience Data Report

I. Stabilizing Medicare Physician Payments

Under the Data-driven Performance Payment System (DPPS):

  • Maximum penalties would be reduced from -9 percent of Medicare Physician Fee Schedule covered professional services to one-half of a physician’s annual update (e.g., 0.25 percent under current law or the increase in the Medicare Economic Index minus 1 percentage point as recommended by the Medicare Payment Advisory Commission), which is similar to other Medicare programs such as the Hospital Inpatient Quality Reporting Program.
  • Any penalties remaining after paying out bonuses would be reinvested penalties in quality improvement and alternative payment model readiness by assisting under-resourced practices with their value-based care transformation.

The 2023 Merit-based Incentive Payment System (MIPS) Performance Period included 541,421 total eligible clinicians (ECs). Here’s how 2023 MIPS scores would translate to Medicare payment adjustments under DPPS:

  • 2.26 percent (12,236) of MIPS ECs received the maximum penalty of nine percent for not participating despite being eligible for MIPS in 2023. Under DPPS, this group would earn half of their payment update.
  • 12.13 percent (65,674) scored below the 2023 performance threshold of 75 points and received a negative MIPS payment adjustment. Under DPPS, this group would receive three quarters of their payment update.
  • 4.75 percent (25,717) scored 75 points and earned a neutral MIPS update. Under DPPS, they would earn their full update.
  • 80.86 percent (437,793) scored above 75 points and earned a MIPS bonus. Under DPPS, they would receive up to 1.25 times their update. The remainder would be distributed to the improvement fund.

II. Mitigating Disproportionate Penalties on Certain Types of Practices to Stabilize Patient Access

2023 MIPS data shows that 29 percent of small practices, nearly 50 percent of solo practitioners, and 18 percent of rural practices received a MIPS penalty. With maximum MIPS penalties of 9 percent, this could significantly jeopardize access to care for vulnerable patient communities. Here is a breakdown of how DPPS payment adjustments would look for these practices based on 2023 MIPS data:

MIPS 2023 data

As shown below, DPPS would also level the playing field among specialties, thereby preserving access to primary and specialty care services particularly in rural and underserved areas.

DPPS would reinvest any remainingfunds collected through penalties not paid out in bonuses for high performers to small, rural, safety net, and other types of under-resourced practices to assist with value-based care transformation efforts. Funds could be used to hire care managers, purchase Certified Electronic Health Record Technology (CEHRT), and so on.

Moving Physicians to Value-Based Care: Merit-based Incentive Payment System (MIPS) Legislative Improvements

By replacing the current tournament model of payment adjustments with a more sustainable approach tied to annual payment updates and incentivizing CMS to share data with physicians, this legislation would stop the harmful penalties on small and rural practices while equipping physicians with timely feedback to improve care and reduce avoidable costs. This legislation would also rename the program as the Medicare Physician Data-Driven Performance Payment System (DPPS). DPPS would address two major shortcomings in MIPS:

1.Address Steep Penalties that Hurt Small and Rural Practices

Problem: MIPS subjects physicians to penalties of up to nine percent unless they meet onerous program requirements. Yet it is extremely burdensome and costly to participate and do well in MIPS. Compliance with MIPS costs $12,800 per physician per year and physicians spend 53 hours per year on MIPS-related tasks. This is why small, rural, and independent practices, along with practices that care for more patients who are dually eligible for Medicare and Medicaid, are more likely to be penalized, whereas large group practices, integrated systems, and alternative payment model participants are more likely to receive bonuses. The 2023 Quality Payment Program Experience Report shows that 29% of small practices, nearly 50% of solo practitioners, and 18% of rural practices received a MIPS penalty, which could jeopardize access to care for patients.

DPPS solutions:

  • Freeze the performance threshold at 75 to promote stability in MIPS. GAO will conduct a study in consultation with national medical specialty societies and make recommendations to Congress and HHS about an alternative threshold methodology.
  • Eliminate the MIPS win-lose style payment adjustments and instead link physicians’ MIPS performance to a portion of their annual payment update (e.g., 0.25% under MACRA or the percentage increase in MEI).
  • Reinvest penalties in bonuses for high performers, as well as investments in quality improvement and APM readiness with a targeted emphasis on assisting small, under-resourced practices.

2. Prioritize Timely and Actionable Data to Reduce Avoidable Costs and Improve Patient Outcomes

Problem: CMS has not met its statutory obligation1 to provide timely (e.g., quarterly) MIPS feedback reports and Medicare claims data to physicians. Instead, CMS issues a single feedback report after the performance period, up to 18 months after applicable services and care were provided.

DPPS solution: Hold CMS accountable for fulfilling its statutory obligations by exempting from DPPS penalties any physicians who do not receive at least three quarterly data reports during the performance period. These reports allow physicians to monitor their ongoing performance and identify gaps or variations in care that can be used to improve quality of care, care outcomes, and reduce costs.

1 §42 USC 1395w-4(q)(12) requires the Secretary to provide timely (e.g., quarterly) MIPS quality and cost feedback, as well as claims data feedback about items and services furnished to patients by other providers and suppliers, similar to data provided to Medicare Shared Savings Program accountable care organizations.

Read discussion draft here.

Rushing Medical Malpractice Legislation Could Have Unintended Consequences

During the 2026 General Assembly session, Senate Bill 536 (SB 536) was transformed into a bill to significantly increase the medical malpractice cap in Virginia. As written, the bill will raise the cap from $2.75 million to $6 million. This bill has moved fast and faced highly unusual circumstances. Despite these intense conditions, the General Assembly has demonstrated a willingness to engage with the concerns of the medical community. The bill was passed by the House of Delegates, and we still have much work to do.

Consequences for our Patients

Over the past decade, many independent physicians have had to close their practices because of increased costs, impacting countless numbers of patients across the Commonwealth. This predominantly affects small and rural health systems who regularly care for patients who rely on Medicaid, Medicare, or who have no insurance at all. When access to primary or preventive care disappears, patients often have only one option: the emergency department. With Virginia’s ERs already overcrowded, our safety net is suffering. At the same time, Virginia is approaching a significant Medicaid fiscal challenge in 2027, when the Commonwealth could assume billions in additional costs. Increasing medical malpractice premiums would further raise the cost of care without improving access for patients.

Consequences for our Clinicians

From the first days of training, physicians are guided by evidence‑based care, clinical judgment, and the ethical obligation to do what is medically necessary for each patient. Physicians and the entire healthcare team came into this profession to care for patients and to be at the table to ensure healthcare is fair, ethical, and the highest quality. Putting patients first is our profession’s mission and the essence of our training.

Just like when caring for patients, the Medical Society of Virginia and its members aren’t leaving the room or closing the door on the medical malpractice conversation. Throughout 2025 and into 2026 we never left the room and worked over and over again to protect the Commonwealth as this legislation evolved. MSV’s guiding mission is to preserve a medical malpractice cap that protects both patients and clinicians, and to reduce harm in a rapidly changing environment. Legislation that significantly alters the medical liability system requires careful analysis grounded in credible health policy data. By staying at the table as legislators, physicians, and patients, we will be able to come to a solution that is truly best for the Virginians we have sworn to protect.

Give Virginia more time to assess the effects on our healthcare system!

The Medical Society of Virginia has requested of our legislators that we continue our work on this complex issue after the legislative session, given the complexity of all of the issues that the bill brings with it. We have respectfully asked that the proposed legislation be postponed for this year, and studied while the Legislators are of out of session to work through the complexities. The MSV will continue to work with other stakeholders for a solution best for all Virginians. We are asking that our patients support our efforts as well.

Signed by MSV Presidents and 2026 Executive Committee

Carol S. Shapiro, MD, MBA ‑ 1998
Lawrence E. Blanchard III, MD ‑ 1999
Randolph J. Gould, MD ‑ 2001
William A. Hazel, Jr., MD ‑ 2002
Mitchell B. Miller, MD ‑ 2004
David A. Ellington, MD ‑ 2005
Norris A. Royston, Jr., MD ‑ 2006
Richard M. Hamrick II, MD, MBA ‑ 2008
Thomas W. Eppes, Jr., MD ‑ 2009
Daniel Carey, MD‑ 2010
Cynthia C. Romero, MD, FAAFP ‑ 2011 Russell C. Libby, MD FAAP ‑ 2013
Sterling N. Ransone, MD, FAAFP ‑ 2014
William C. Reha, MD, MBA ‑ 2015
Edward G. Koch, MD, FACOG ‑ 2016 Bhushan H. Pandya, MD‑ 2017
Kurtis Scott Elward, MD ‑ 2018

Richard A. Szucs, MD ‑ 2019
Clifford L. Deal, III, MD ‑ 2020
Arthur J. Vayer, Jr., MD, FACS ‑ 2021
Mohit Nanda, MD ‑ 2022
Harry L. Gewanter, MD, FAAP, MACR ‑ 2023 Alice T. Coombs, MD, FCCP, MPA ‑ 2024
Joel T. Bundy, MD, FACP, FAAPL, CPE ‑ 2025
Mark D. Townsend, MD, MHCM ‑ 2026

2026 Executive Committee Members
Arturo P. Saavedra, MD, PhD, MBA, FAAD
Steven J. Lewis, MD, MPH
Michele A. Nedelka, MD
Marc C. Alembik, MD
Stephen P. Combs, MD, CPE, CPHQ,
FACFE, FAAP
Brenda L. Stokes, MD

Write your representatives today using our Voter Voice and tell them to OPPOSE ANY VERSION OF SB 536 THAT HURTS HEALTHCARE!

Oppose SB 536

‘SUCK IT UP, BUTTERCUP,’ DOCUMENTARY SETS MARCH 19 BALTIMORE SCREENING TO SPOTLIGHT SYSTEMIC PRESSURES IN U.S. MEDICINE

Film Examines Corporate Greed, Silenced Patients and the Systematic Destruction of American Medicine

BALTIMORE, MD, UNITED STATES, February 20, 2026 / EINPresswire.com / — At a time when healthcare systems nationwide are navigating workforce shortages, financial strain and evolving regulatory pressures, the documentary ” Suck It Up, Buttercup: Trust & Betrayal – Healthcare in America,” will screen in Baltimore on March 19, at 7 p.m at the historic The Senator Theatre.

Hosted by the Irreverent Health podcast team, the event is open to healthcare professionals, executives, policymakers, students, and anyone who is frustrated with the state of the healthcare.The film examines how unchecked corporate greed — driven by private equity takeovers, predatory consolidation, and profit-first reimbursement models — has gutted the U.S. healthcare system from within. Patients pay the highest price: their voices silenced, their care decisions overridden by administrators who have never set foot in an exam room, and their trust in medicine systematically eroded.

Through interviews with frontline physicians, healthcare leaders, patient advocates, and policy experts, “Suck It Up, Buttercup,” presents perspectives from inside exam rooms and executive offices, exploring how financial priorities and compliance demands intersect with clinical decision-making.

Crucially, the film amplifies patient voices — people whose care has been denied, delayed, or degraded — ensuring those most affected by corporate greed in healthcare are finally heard.

“This film pulls back the curtain on how the prioritization of profits over people has fractured trust in healthcare,” said Executive Producer Todd R. Otten, MD. “It reveals the human cost of a system where administrators and stakeholders often protect financial interests at the expense of patient care and clinician wellbeing.” “Greed is not a business strategy — it is a destruction strategy. And American patients are paying the ultimate price.”

“Suck It Up, Buttercup,” examines the increasing role of bureaucracy and financial incentives in modern medicine,” said Executive Producer MaryAnn Wilbur, MD, MPH, MHS. “It addresses the learned helplessness many clinicians describe and invites a broader discussion about leadership accountability and long-term sustainability in healthcare. What is too often missing from these conversations is the patient,“ she adds. “This film insists that the patient voice be heard — not as an afterthought, but as the entire point.”

Directed by the collaborative team of Amy Schrob, Scott Pressler, John Mottern, MaryAnn Wilbur and Todd Otten, the documentary features physicians, nurses, healthcare executives and policy voices discussing operational realities, including documentation burdens, productivity targets, consolidation and shifting governance structures.

Executive producers, Otten and Wilbur lead the producing team that includes The American Academy of Emergency Medicine along with John Hunter Mottern, Director of Photography, Producer, Scott Pressler, Creative Director, Producer, and Amy Schrob, Editor, Producer.

Featured participants include Mark Cuban; Dr. and Lady Glaucomflecken; Wendy Dean, MD; Leah Carpenter, RN; Ashley Chancellor, RN; Dike Drummond, MD; Don Berwick, MD; Mark Reiter, MD, Tammy Scott, RN; Terrence Mulligan, MD; Rebecca Wood; Camille Burnett, PhD; Linda Peeno, MD; Wendell Potter; Matthew Zachary; Taylor Paige Borque, RN; Tina Shah, MD; Steve Abelowitz, MD; and Kemia M. Sarraf, MD.

For Baltimore — home to globally recognized healthcare institutions, academic medical centers, and a robust life sciences ecosystem — the screening offers an opportunity to engage in dialogue around workforce stability, leadership responsibility, and the business decisions shaping care delivery.

The screening is open to the public and will include a post-film discussion.

Tickets and additional information are available at: https://irreverenthealth.com/suck-it-up-buttercup/

About “Suck It Up, Buttercup: Trust & Betrayal – Healthcare in America”:

The documentary explores systemic pressures within the U.S. healthcare system and their impact on patient care, clinician wellbeing, and organizational culture. The film is produced by Buttercup Productions and its executive producing team. The film makes the case that unchecked greed — through private equity, corporate medicine, consolidation, and profit-first mandates — has devastated U.S. healthcare, and that restoring it requires centering the patient voice above all else.

For more information about the film visit https://suckitupbuttercupfilm.com.

Official teaser: https://www.youtube.com/watch?v=p2g6yxyUydY

Read full press release HERE.

Updates on Virginia Department of Health Vaccine Recommendations

To date, VDH has now reported 10 cases of measles in 2026 — twice the number of measles cases reported in all of 2025. Although the Virginia Department of Health (VDH) has not yet identified a measles outbreak or evidence of community transmission in Virginia, the recent increase in cases both in Virginia and nationally is a good reminder of the importance of vaccines in protecting our communities. As we continue our shared mission to safeguard our communities, we would like to provide the following updates and reminders regarding childhood and adolescent immunizations.

On January 5, 2026, the U.S. Department of Health and Human Services (HHS) announced significant changes to the Centers for Disease Control and Prevention’s (CDC) childhood immunization schedule. This change was made in the absence of new data or safety signals to prompt such an update. On January 26, 2026, the AAP published its Recommended Childhood and Adolescent Immunization Schedule, US, 2026. The updates below reflect that VDH vaccine recommendations are clear and grounded in science, enabling informed conversations and decisions between families and their healthcare providers.


American Academy of Pediatrics 2026 Immunization Schedule

Vaccinations play a critical role in protecting the health of children, families, and communities.
VDH strongly recommends that all children in the Commonwealth be vaccinated in accordance with the American Academy of Pediatrics (AAP) Recommended Child and Adolescent Immunization Schedule. After thorough review of the various schedules, our agency believes that AAP’s recommended schedule best reflects the existing science on how to optimally protect Virginia’s children and adolescents against 18 vaccine-preventable diseases.


VDH expects healthcare providers to continue relying on their clinical training and professional judgement, and to consult information published by the American Academy of Pediatrics and the American Academy of Family Physicians when engaging in shared clinical decision-making with parents, caregivers, and patients. Vaccines remain widely accessible in Virginia and VDH expects Virginia healthcare providers to continue to offer these vaccines to children and adolescents. As you know, a healthcare provider’s recommendation remains one of the most powerful factors in a person’s decision to receive a vaccine.

Virginia’s Vaccine Requirements for School Attendance Remain Unchanged

Please note that the minimum immunization requirements for school entrance in Virginia are outlined in the Code of Virginia and remain unchanged as compared to last school year. Additional information on school immunization requirements can also be found on our webpage: School Requirements – Immunization.

VDH will continue to rely on systematic and transparent review of scientific evidence to inform any future updates to immunization requirements, guidance, or practice. Thank you for your collaboration in keeping Virginia’s families healthy and safe.

Sincerely,
B. Cameron Webb, MD, JD
State Health Commissioner

The AMA secured eight major wins for medicine

The American Medical Association (AMA) has delivered eight major wins for physicians and patients—wins that did not happen by chance. They happened because the AMA fought relentlessly on your behalf.

The federal government funding package passed Tuesday includes several AMA-backed provisions that will directly impact your practice and strengthen patient care:

  1. Medicare telehealth coverage extended for two more years, preserving essential access for patients nationwide.
     
  2. A 3.1 percent bonus reinstated for physicians in Medicare alternative payment models, helping stabilize practices participating in value-based care.
     
  3. Expansion of the Medicare Diabetes Prevention Program to include virtual services through 2029, improving access for at-risk patients.
     
  4. New requirements for Medicare Advantage plans to maintain accurate, regularly updated provider directories, reducing administrative burdens and patient confusion.
     
  5. Extension of the Acute Hospital Care at Home waiver through 2030, supporting innovative, physician-led care models.
     
  6. A five-year extension of the Dr. Lorna Breen Health Care Provider Protection Act, continuing vital efforts to reduce stigma around physician mental health.
     
  7. Targeted PBM reforms that increase transparency and move us closer to lowering prescription drug costs for patients.
     
  8. Reauthorized PREEMIE Reauthorization Act, expanding research on preterm birth, and the Preventing Maternal Deaths Act, increasing funding to $100 million annually through 2030 to prevent maternal mortality.

When combined, these hard-fought victories demonstrate something more powerful than legislative wins alone. They represent what is possible when physicians stand together and when lawmakers find common ground to support better care. Learn more here.