In order to combat the challenges of American healthcare today, a federal CMS Healthcare Advisory Committee was recently selected from more than 400 nominations. Among its 18 members, not one independent private practice physician who manages chronic illness in the community on a daily basis was represented. This omission is striking.
After more than 30 years practicing neurology as a solo private practice neurologist, I was surprised to see no community-based physicians on the committee. My patients are Medicare beneficiaries with complex chronic conditions, including multiple sclerosis, epilepsy, dementia, and Parkinson’s disease. These illnesses require ongoing management, care coordination, and long-term relationships. Independent physicians face a very different reality than large health systems. We handle administrative burdens such as prior authorizations, precertifications, and Medicare Advantage restrictions without layers of support staff. We are often the only consistent point of contact for patients and families over many years. Medicare payment structures heavily favor hospital-employed physicians, reimbursing them far more for the same services. Adjusted for inflation, physician reimbursement has fallen more than 30% over the past 25 years, threatening the survival of independent practice.
The makeup of the committee presents the wrong narrative. It includes hospital systems, Medicare Advantage executives, value-based care organizations, health IT leaders, and even the incoming chair from a major hospital lobbying firm. Venture capital, consulting, and corporate interests are well represented. Missing entirely are independent physicians, rural hospital leaders outside large systems, and patient advocates. Federal advisory committees are meant to reflect balanced perspectives on the issues they address. In healthcare, independent, community-based physicians represent a distinct model of care defined by continuity, longitudinal management, and direct accountability to patients rather than institutions. When that voice is absent, policymakers miss the practical realities of delivering care to millions of Medicare beneficiaries.
This imbalance is not accidental. The committee’s makeup aligns decision-making with those whose incentives favor corporate consolidation. Hospital-employed physicians must answer to CEOs and administrators whose primary goals are often financial performance and institutional priorities rather than direct patient care. If Medicare fails to recognize the pressures driving independent practices out of business, especially for those managing chronic illness in the community, patients will lose access to the continuity and personalized care that independent physicians provide.
To address this, the Department of Health and Human Services should require a representative number of designated seats for independent, community-based physicians on these committees. Congress should pursue comprehensive reform of prior authorization and precertification requirements, eliminating them for routinely approved, evidence-based treatments in chronic disease management. Policymakers must also confront healthcare consolidation by strengthening antitrust scrutiny and expanding site-neutral Medicare payments so independent practices are not financially penalized for delivering the same care. Additional critical steps include limiting the role that health insurance companies impose on doctors and their patients, restoring free-market competition in the healthcare system, eliminating merit-based incentive payment system (MIPS) for small independent private practices, and creating strong incentives for young doctors to enter private practice. Medical schools and residency programs currently show little interest in teaching the business and operational skills needed for independent practice, so we must require dedicated curriculum and real-world exposure to private practice models during training. Preserving a diverse care landscape is essential because without the voices of independent physicians, healthcare policy will continue to serve institutional interests over patients.
Who else is missing from the committee? Share your perfect committee in the comments.
Dr. Tzorfas is a neurologist with more than 30 years in independent private practice, who sees firsthand how current Medicare payment structures and administrative burdens are driving independent physicians out of business and limiting patient access.
Image by Boris Zhitkov / Getty Images
