🏛️ Policy & Payers

⭐ Just for Fun

It’s the first full operational week of 2026. As the CY 2026 Medicare Physician Fee Schedule goes into effect, much of the early attention has focused on the finalized efficiency adjustment to work RVUs for procedural codes. That adjustment is real and worth paying attention to. But it’s not the full story of what Centers for Medicare & Medicaid Services is signaling to independent practices.

For the first time in several years, the payer landscape and the consumer landscape are moving in the same direction: away from transactional volume and toward longitudinal relationships.

For years, protecting margin has typically meant keeping schedules full and patient volume high. The 2026 fee schedule reflects a broader recognition of the cognitive and relational work involved in managing complex, ongoing conditions, including continued support for add-on codes like G2211. It reinforces that the value of care extends beyond the procedure itself and includes the continuity and coordination that surround it.

Patient behavior is shifting as well. Interest is moving toward longer-term skin health and maintenance, with “skin longevity” increasingly reflecting how patients want to engage with their care over time.

Viewed together, these shifts are beginning to change how practices think about their models. The distinction between “medical” and “aesthetic” care feels less rigid, with retention emerging as a shared priority across the practice.

High-churn care models are starting to feel tighter. Recent efficiency adjustments leave less room for operational error, and reliance on remote visit volume remains unsettled with current telehealth flexibilities set to expire later this month. Dermatology, however, is a fundamentally procedural specialty. The majority of revenue continues to be driven by in-office evaluation and management paired with procedures, which materially insulates dermatology practices from these shifts. As a result, these changes are unlikely to have a meaningful impact on our clients or most well-run dermatology practices.

In addition, dermatology benefits from a meaningful and durable cash-pay component that does not exist in most other medical specialties. Aesthetic services, cosmetic procedures, and elective treatments provide practices with revenue that is not dependent on payer policy, telehealth rules, or utilization management changes. This diversified revenue mix creates a level of stability and flexibility that few specialties can replicate.

Independent dermatology practices are particularly well positioned. Without centralized growth mandates or rigid, volume-first playbooks, owners can balance insured and cash-pay services, optimize schedules around in-office care, and invest in long-term patient relationships. That autonomy leads to more predictable cash flow, healthier margins, and less sensitivity to external reimbursement shocks.

What stands out heading into 2026 is that this operating model increasingly aligns with both how dermatology is reimbursed and how patients want to engage with care: in-person, relationship-driven, and procedure-oriented, with optional cash-pay services layered on top. Practices that stay focused on these fundamentals are not just insulated from near-term uncertainty — they are structurally advantaged.

Many practices are taking a closer look at a few familiar areas because the context around them is changing.

Longitudinal care. There’s growing attention on whether documentation and care models reflect the ongoing complexity of certain patient relationships rather than treating each visit as a standalone event.

Procedural mix. Instead of automatically leaning on higher throughput to offset reimbursement pressure, some practices are reconsidering how procedures fit into longer-term care plans that support repeat engagement over time.

Language in aesthetic consults. Early conversations are starting to shift toward planning. Framing care in longer horizons, rather than single treatments, mirrors the longitudinal mindset on the medical side and helps create more predictable patient relationships.

None of these shifts require a reinvention of how practices operate. They point to a gradual recalibration that many owners are already noticing in day-to-day decisions.

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This one was super fun. Hope you enjoyed it too.