AUGS Submits CY 2026 PFS Comment Letter

What this means for you: AUGS continues to engage with CMS to improve physician payment and showcase the importance of urogynecologists.

On September 12, AUGS submitted comments to CMS on the CY 2026 Medicare PFS proposed rule. Our letter highlighted several key issues:

Conversion Factor Update: CMS proposed a modest increase to the physician conversion factor for 2026, but AUGS cautioned that temporary fixes and offsetting cuts highlight deeper flaws in the payment system. Outdated budget neutrality rules and the lack of an annual inflationary update-like the one hospitals receive-are eroding practice sustainability and patient access, especially in rural and underserved areas. AUGS urged CMS to work with Congress on permanent updates to stabilize physician payments.
Efficiency Adjustment: CMS proposed a 2.5% "efficiency adjustment" cutting physician work values for many services. AUGS strongly opposed this approach, noting that shorter procedure times do not necessarily mean less work and may even reflect greater complexity. Policies that equate time with work risk discouraging innovation and send the wrong signal about patient care priorities. AUGS also cautioned that applying broad productivity cuts at the service level risks double-counting efficiencies already addressed through the RUC process.
Practice Expense Methodology: CMS proposed changing how indirect practice expenses are calculated, a shift that would reduce PE RVUs for facility-based services. AUGS strongly opposed this approach, noting that practices-including independent practices that maintain office infrastructure-still bear significant indirect costs even when care is furnished in a facility. The proposed cuts fail to reflect these realities and risks destabilizing practice sustainability and patient access.
Provider Home Address: CMS did not propose extending the current policy that lets physicians delivering telehealth from home use their practice address instead of their home address. AUGS urged CMS to continue this flexibility to protect physicians' privacy and personal safety, while also reducing unnecessary administrative work.
Direct Supervision: CMS proposed to make permanent the option for physicians to meet direct supervision requirements through real-time audio-video technology. AUGS supported this policy and encouraged CMS to explore expanding these flexibilities to additional services over time.
Teaching Physician Virtual: CMS plans to end the policy that allows teaching physicians to supervise residents virtually in all settings, limiting it to rural sites only. AUGS opposed this change, stressing that keeping virtual supervision available in all training environments is critical to building and sustaining the women's health workforce.

Congress Debates FY 2026 Appropriations

What this means for you: How the NIH will be funded in FY 2026 remains up in the air, although there is large bipartisan support in Congress to maintain the current structure and funding for the NIH to protect federal research.

Lawmakers have returned to Washington DC after a month-long August recess, with their main focus on funding the government for FY 2026 before the September 30 deadline. The House and Senate Appropriations Committees are pursuing differing bills to fund HHS for FY 2026. The House bill would provide $108 billion for HHS compared to $117 billion in the Senate bill. President Trump requested $94 billion in his budget proposal from earlier this year. The Senate draft report, which accompanies its appropriations bill, includes directives to the NIH to continue to fund women's health research workforce programs, as was requested by AUGS and the Women's First Research Coalition. The House draft report encourages NICHD to convene a workshop to design prospective studies related to pelvic organ prolapse.

Both the House and Senate bills would essentially maintain current funding levels for the NIH, rejecting the budget request from the Trump administration to cut the NIH by about 40%. Further, neither bill included the proposal from President Trump to consolidate ICs. It is likely that neither bill in current form will pass, and there is likely to be a continuing resolution to fund the government beyond September 30 to give lawmakers more time to finalize FY 2026 bills. However, there is always a possibility of a government shutdown if an agreement is not reached.

NIH Developments are Changing the Federal Grant Process

What this means for you: The Trump administration continues to politicize NIH research funding related to issues not in line with its priorities.

Recent policy and legal developments related to NIH grantmaking are changing the federal grant dynamic and have implications for current and future research grants.

Executive Order on Grantmaking: President Trump signed an executive order in August that reaffirms how this administration has approached federal grants, stating that political appointees must review grant awards to ensure they are consistent with agency priorities. It states that preference for awards should be given to institutions with lower indirect cost rates and that awards should not fund or promote racial preferences or denial of the sex binary. It also requires agencies to allow grants to be terminated for convenience.
NIH Policy on AI: Effective September 25, the NIH will not consider research applications that are either substantially developed by AI, or contain sections substantially developed by AI, to be original ideas of applicants. Also, NIH will only accept six new, renewal, resubmission, or revision applications from an individual Principal Investigator/Program Director or Multiple Principal Investigator for all council rounds in a calendar year, due to concerns of AI usage.
Supreme Court Decision on DEI Grant Cancellations: The Supreme Court overturned a lower court ruling that declared the cancellation of $783 million in NIH grants as illegal. The administration had targeted the grants by noting the funding was tied to DEI and other policy initiatives. The Supreme Court's ruling is not a final decision on the legality of the grant terminations, but it means the administration can withhold the funding while the legal fight plays out.

AUGS Holds Webinar on Advocacy Basics

What this means for you: The webinar recording will be available next week on AUGS Online Learning. In the meantime, sign up here to become an advocacy volunteer.

Our consultants from McDermott+ provided an overview of the current political landscape and discussed the importance of advocacy for protecting our subspecialty. The webinar also highlighted how AUGS members can engage in advocacy at various levels, so you can pick the mode that works best for you.

ORWH to Hold October ACRWH Meeting

What this means for you: AUGS members should consider attending the virtual October 7 meeting to hear from NIH staff.

The ORWH will hold its second virtual ACRWH meeting of the year on October 7. The ACRWH gives advice and makes recommendations to the ORWH on priority issues affecting women's health and sex differences research. The meeting will include a report from the ORWH Director, opening remarks from NIH Director Bhattacharya, and a presentation and panel on women's health. During the last meeting in June, AUGS member Dr. Milena Weinstein was the sole individual to provide oral comments.

New AUGS Issue Briefs

AUGS has developed three new issue briefs in line with our advocacy priorities:

AUGS will use the briefs for education and advocacy efforts.

Health Policy and Payment Update

Key takeaways: