Only 29% of medical group leaders say their practice received its most recent commercial payer rate increase within the past year, according to an Aug. 25, 2026, MGMA Stat poll. Another 17% said their last increase came one to two years ago, while half (50%) said it had been three years or longer. Another 4% selected N/A. The poll had 203 applicable responses.

Meanwhile, practice expenses continue to rise. More than 8 in 10 groups report higher year-to-date operating costs this year, while less than half (47%) report increased revenue to help keep pace.

For the two-thirds of respondents who said their most recent commercial rate increase came more than a year ago, working from an older fee schedule is a clear imbalance: today's wages, supply costs and rent are being supported by reimbursement rates set years earlier.

Why commercial rates can stay unchanged for years

One reason is simple: many commercial contracts renew automatically. If no one tracks the dates and starts the process, another contract year can begin with the same rates.

An Aug. 15, 2023, MGMA Stat poll found that 58% of medical groups reviewed payer contracts annually, while 17% did not review them on any regular schedule. Reviewing an agreement also does not mean reopening it for negotiation. In smaller organizations, that work may compete with billing problems, credentialing, staffing and other daily responsibilities.

Practices also need data to show how their current rates compare with the market. Transparency in Coverage rules have made payer-negotiated rate information publicly available, but using those files remains difficult for many groups. A Dec. 30, 2025, MGMA Stat poll found that only 18% of medical groups used Transparency in Coverage data in payer negotiations. Another 46% did not, and 36% were unsure.

Leaders who were not using the data cited several reasons, including limited awareness, uncertainty about its value and the time or technology needed to turn large public files into useful CPT-level comparisons.

What leaders told MGMA

Comments from groups that secured an increase within the past year point to several recurring ingredients: a strong market position, benchmarking or other market data, quality metrics and a willingness to push negotiations further when needed. Threatening to terminate the contract was one of the most frequently cited tactics, while several respondents paired market position with benchmarking data rather than relying on a single argument.

Persistence mattered, too. One respondent said it took six months to get a payer to respond after years without an increase, followed by another two months of negotiations. Others said simply asking produced an increase, while some practices relied on contract consultants or built-in contractual rate adjustments.

The comments were markedly different among practices that had gone longer without an increase. For respondents whose last increase was one to two years ago, contract terms, payer refusal and lack of leverage were the most common barriers. Among the three-years-or-longer group, payer refusal and lack of leverage dominated, with staff bandwidth a clear secondary problem. Several respondents described payers that would not discuss rates or lacked an accessible representative.

One private pediatric practice said payers were “flat out refusing to entertain requests for increases.” Another respondent pointed to a different structural problem: its health system accepted lower medical group rates in pursuit of more favorable rates on the acute-care side.

Start with the contracts you already have

MGMA consultant Doral Davis-Jacobsen's payer contracting checklist starts with a basic inventory: every executed payer agreement, the products covered by each contract, and the date it was last negotiated.

For practices that cannot readily answer when their largest commercial contracts were last renegotiated, that inventory is the place to begin.

The next step is assembling the information needed to decide where an increase would matter most:

• Payer mix and gross collections by payer, using a full year of data.
• CPT-level fee schedules for the codes that generate at least 80% of revenue.
• Cost per visit or procedure for those services.
• An assessment of the administrative burden created by each major payer.

Practices also need a business case for the request. Davis-Jacobsen has described a North Carolina ophthalmology practice that compared its total cost for cataract surgery with the highest-cost provider in its market. The analysis showed savings of more than $6,200 per case, giving the practice a specific value argument to take to the payer.

From there, practices can prioritize the commercial payers with the greatest financial impact and set a specific rate target for each one. Starting several months before renewal gives the group time to gather CPT-level data, model the effect of different rates and get negotiation calls scheduled.

This poll’s responses add an important point: data alone may not be enough. Practices that recently won increases frequently paired their evidence with something that strengthened their negotiating position — market importance, quality performance, persistence or a credible willingness to walk away.

Check that the new rates are being paid

The work continues after an agreement is signed.

A January 2021 MGMA Stat poll found that 47% of practices audited payer contracted rates annually and 28% did so more often. Once new rates take effect, practices should load the updated fee schedule, spot-check high-volume codes within 60 days and track underpayments by payer.

MGMA's Physician Fee Schedule Tool can help practices compare fee schedule versions by year and locality with non-Medicare rates, making it useful both when preparing for negotiations and when checking payments afterward.

For practices with Jan. 1 renewals, late summer is already part of the contracting calendar. The immediate work is straightforward: identify when major commercial agreements were last negotiated, decide which payers deserve attention and begin assembling the data behind the request.

For the half of respondents who have gone three years or longer without an increase, the comments suggest starting even more basically: find the contract, identify who owns the payer relationship, determine what leverage the practice can bring to the discussion and put the next renewal date on the calendar.

Notes

1. Harrop C. "Is it time to review your medical group's payer contracts?" MGMA. Aug. 16, 2023. https://www.mgma.com/mgma-stat/is-it-time-to-review-your-groups-payer-contracts  
2. Harrop C. "Using TiC negotiated-rate data to negotiate smarter payer contracts." MGMA. Dec. 31, 2025. https://www.mgma.com/mgma-stat/using-tic-negotiated-rate-data-to-negotiate-payer-contrac
3. Harrop C. "Operating costs keep climbing for medical practices in 2026." MGMA. June 24, 2026. https://www.mgma.com/mgma-stat/operating-costs-keep-climbing-for-medical-practices-in-2026
4. Harrop C. "Revenue growth narrows as costs climb: the 2026 squeeze on medical practices." MGMA. July 2, 2026. https://www.mgma.com/mgma-stat/revenue-growth-narrows-as-costs-climb-2026-squeeze
5. Davis-Jacobsen D. "Payer Contracting Checklist: 10 action items to optimize your negotiations." MGMA member tool. https://www.mgma.com/member-tools/payer-contracting-checklist-10-action-items-to-optimize-your-negotiations
6. MGMA Staff Members. "Developing your medical group's value proposition to support payer contract negotiation strategy." MGMA. Jan. 16, 2022. https://www.mgma.com/articles/developing-your-medical-group-s-value-proposition-to-support-payer-contract-negotiation-strategy
7. MGMA. Payer Contracting Playbook. April 23, 2025. https://www.mgma.com/playbooks/payer-contracting
8. MGMA. Analyzing Payer Contracts Playbook. May 8, 2025. https://www.mgma.com/playbooks/payer-contract-analysis
9. MGMA. Physician Fee Schedule Tool. https://www.mgma.com/content-tools/physician-fee-schedule-tool
10. MGMA Stat. "New year's resolution: Optimizing audits of your practice's payer contracted rates." Jan. 5, 2021. https://www.mgma.com/mgma-stats/new-year-s-resolution-optimizing-audits-of-your-medical-practice-s-payer-contracted-rates