Last week's MGMA Stat poll confirmed a now-familiar pattern on operating costs: 84% of medical groups reported year-to-date costs higher than the same period in 2025, with labor, supply and drug costs, and insurance and overhead leading the way. The revenue side of that same financial picture is harder to read — and in 2026, that's by design. 

Our June 30, 2026, MGMA Stat poll finds 47% of medical groups reporting total revenue YTD higher than the same period in 2025, 14% reporting it about the same, 36% reporting a decrease and 2% unsure. The poll had 221 applicable responses. 

For context, a June 17, 2025, MGMA Stat poll on the same question found just 56% of medical group leaders reporting YTD revenue increases versus 2024 — with 13% flat, 30% reporting a decline and 1% unsure.  

The gap between practices gaining ground and losing it has narrowed sharply. A year ago, 56% reported higher revenue and 30% lower — a 26-point lead for the gainers. This year it's 47% up against 36% down, a lead of just 11 points, and the share reporting flat or falling revenue rose from 43% to 50%. Costs are the more predictable half of the picture: nearly every practice has reported paying more, year after year, easing only slightly to 84% this year. Revenue has always been more of a mixed bag. Two big shifts explain most of what changed. 

What you told us 

• "Saw more patients; increased reimbursement through contract negotiations." — a group reporting higher YTD revenue 
• "Larger clinic volume combined with declining payment per CPT code made for flat revenue." — a group reporting revenue about the same as 2025 
• "Annual increase in salaries, reimbursements not increasing but operating costs are." — a group reporting lower YTD revenue 

Groups reporting higher YTD revenue most often pointed to straightforward volume growth — more visits, cases and encounters — frequently paired with added providers or expanded capacity, including practices absorbing retiring physicians' panels. A second set credited revenue-per-visit gains from payer-contract renegotiations, a stronger payer mix and contractual rate escalators. Others cited new or expanded service lines and ancillaries, along with revenue-cycle gains from better A/R follow-up, coding accuracy and provider documentation. 

Groups reporting flat revenue generally described a tug-of-war, not real stability: more visits, but each one paying less as CPT® code payments and reimbursement rates fell and more of their patients shifted to Medicare. Prior-authorization friction, denials and labor costs outpacing revenue were also named as forces holding the top line in place. 

Declining-revenue groups most often cited falling patient and visit volume, frequently tied to provider attrition — physicians retiring, departing or on extended leave, with capacity not fully backfilled. Reimbursement pressure was the second recurring theme: stagnant or reduced rates, Medicaid and commercial cuts, and a shift toward Medicare, Medicaid and self-pay, compounded by denials and downcoding. A handful said patients were simply coming in less — often putting off care because high-deductible plans left them paying more out of pocket — even as operating costs kept rising against flat collections. 

Medicare: a headline increase with a service-line catch 

CMS finalized a 2026 conversion factor of $33.57 for QPs and $33.40 for non-QPs — increases of 3.77% and 3.26%, respectively, driven largely by a 2.5% OBBBA statutory adjustment. But CMS also finalized a -2.5% efficiency adjustment to work RVUs and intraservice time for more than 7,000 non-time-based CPT codes (procedures, diagnostic imaging, outpatient interventions, interventional pain, orthopedics), plus a site-of-service differential that cuts indirect practice expense allocation in the facility setting by 50%. E/M, behavioral health, care management, telehealth and maternity codes are exempt.  

Net effect: the change shifts value toward time-based specialties and away from procedural ones — especially those working in facilities, where the cut can top 5% on work RVUs and, for cardiology facility services, roughly 10% on total RVUs. Because the same procedure now counts for fewer RVUs, any physician paid per wRVU sees their measured productivity — and their pay — drop in 2026 even if they do exactly the same amount of work. CMS is expected to recalculate this every three years. 

ACA marketplace: the most disruptive year since launch 

The ACA marketplaces entered 2026 without the enhanced premium tax credits that had expanded affordability since 2021. Before open enrollment, a Peterson-KFF analysis of insurer filings found a median proposed premium increase of 18% across 312 marketplace insurers, and estimated that subsidized enrollees who kept comparable coverage would see annual premium payments more than double, from $888 to $1,904. 

Sign-ups took the first hit: plan selections fell to 23.1 million, a drop of more than 1 million and the sharpest one-year decline since the marketplaces launched. But a plan selection is not paid coverage, and the gap between the two is crucial. In late June, HHS released the first reported 2026 effectuated enrollment — coverage people actually paid for — at 19.2 million as of February, measured after the nonpayment grace period closed. That's nearly 4 million below January's sign-ups and roughly 3 million under 2025's paid total. It confirms, with hard numbers, what Wakely had only projected from early-payment data: only about 86% of January enrollees paid a first premium, and coverage would keep eroding through the year. Internal CMS documents reported by NOTUS put a finer point on the mechanism — about 21% of HealthCare.gov enrollees were dropped in early 2026 for nonpayment. 

Why the number fell is contested. An HHS report credits program-integrity efforts that stripped out improper or duplicate enrollments; KFF, provider groups and consumer advocates tie the drop mainly to affordability once the enhanced subsidies lapsed. Regardless of the cause, the result for a medical group is the same: fewer patients holding paid marketplace coverage than sign-up totals implied, and more of that loss landing mid-year rather than at renewal. 

The erosion wasn't evenly spread. Adults 18 to 34 — younger and generally healthier — accounted for more of the sign-up drop than any other age group, and enrollees just above the subsidy cliff left at high rates. As healthier members exit, the pool left behind skews sicker and costlier to cover, part of why insurers are pulling back: Aetna exited the individual exchanges for 2026, and Cigna will leave after the 2026 plan year. State patterns vary widely — selections fell in 41 states, steepest in North Carolina, Ohio and West Virginia, while New Mexico rose 18% on state assistance that backfilled some of the lost federal support. 

For the patients who keep marketplace coverage, the plans themselves look different: 

•  The share of consumers in bronze plans rose from 30% to 40%, while silver fell from 57% to 43%. 
• Average deductibles rose 37%, from $2,759 to a record $3,786. 
• Among returning enrollees who switched plans, 26% downgraded metal tier. 
• Cost pressure is already visible: 80% of returning enrollees reported higher 2026 premiums, deductibles, coinsurance or copays; 49% worried about affording routine visits; and 55% said they had cut back, or planned to, on food or household basics to afford coverage and care. 

Every one of these shifts — coverage lost mid-year, migration to bronze and higher deductibles, more self-pay — moves a practice's payer mix in the wrong direction at exactly the moment most groups need revenue to grow just to keep pace with rising costs. It shows up as more patients gaining and losing coverage mid-year and more retroactive terminations, more patient balances that are harder to collect, more financial-assistance and payment-plan conversations at the front desk, and more scheduling friction for elective and deferrable care. Payer mix used to be a slow-moving budget assumption; in 2026 it's a moving target — and it's moving against the spread. 

A Q3 budgeting watch list 

The 2025 MGMA Financials and Operations data report, Margin in Motion, framed the year around that simple spread: what a practice brings in minus what it costs to run. Costs are still climbing through mid-2026, and revenue is now growing at only a minority of practices — so that gap is getting squeezed from both sides, even as cost increases slow a little. Groups are defending it in different ways. Before Q3 budget assumptions are locked, put eight items on the table: 

1. Build a single-page Medicare impact model by service. Pull the final -2.5% code list from the CMS rule's data files, map your top CPT® codes by volume and revenue, add the facility-setting indirect PE reduction where it applies, and show CY2026 net Medicare revenue picture per provider. Most administrators have heard, "Medicare went up." Few have seen what it actually does after both adjustments. If the result is negative for a procedural specialty, that's a budget revision you can make in Q3 rather than a Q4 surprise. 
2. Audit every wRVU-based compensation arrangement before Sept. 30. Procedural specialists' measured productivity falls mechanically in 2026 and again three years later. Consider three paths: raise the per-wRVU rate to keep total pay flat at the same volume; move to a blended productivity-and-quality metric that’s less exposed to RVU revaluation; or shift to a percent-of-collections structure. Model the dollar impact, confirm changes stay within commercial-reasonableness and FMV ranges, and time renegotiations for the next contract-anniversary window rather than mid-year amendments. 
3. Refresh payer-mix projections now that new enrollment data is out. Build the baseline first: your ACA-exchange and Medicaid-expansion patient share by clinic and specialty, with state-level detail if you operate in more than one. The first reported 2026 effectuated numbers are out — February came in sharply below sign-ups — and CMS' state-level snapshots and later multi-month counts will keep updating through the summer and fall, each one capturing more of the mid-year drop-off. With the baseline built, you can refresh assumptions in a day as each release lands instead of rebuilding from scratch. Watch patients who appeared insured at the time of service but had unpaid premiums; retroactive terminations will keep hitting Q3 and Q4 A/R. 
4. Get the patient financial toolkit ready for the January deductible reset. Q1 2027 will be harder than Q1 2026 if patient cost-sharing keeps rising. Have three workflows in place by November: real-time eligibility and out-of-pocket estimates at scheduling and check-in (not just at charge entry); standard payment-plan terms (e.g., balances over $200 with a $50 minimum monthly, card-on-file autopay) staff don't have to negotiate from scratch; and a vetted third-party financing partner for balances over your practice’s carry thresholds, so larger surgical and procedural balances move off the books on day one rather than aging into write-offs. 
5. Run a denial root-cause sprint in Q3. As patients change plans, downgrade metal tiers and lose coverage mid-year, eligibility-driven denials will spike in the back half of 2026. A two-week sprint can review the top five denial reasons by payer, fix the front-end and coding workflows causing them, and resubmit the recoverable backlog before that cash ages past 120 days. 
6. Stress-test your top three payer contracts. If you haven't renegotiated a commercial rate in the past 24 months, model your top three commercial contracts against current cost-per-RVU and against the Medicare rates you'll actually realize in 2026 after the efficiency adjustment. Practices reporting revenue growth in this week’s poll frequently credited payer-contract renegotiation and stronger contracts; those reporting declines commonly pointed to stagnant or reduced reimbursement rates. That is enough to justify the conversation. 
7. Track carrier exits and map your patient base for 2027. Cigna's marketplace exit takes effect for 2027; Aetna already exited. Identify how much of your patient panel sits with carriers that have exited, are exiting, or are reducing market participation. Start retention work before annual enrollment, not after patients receive non-renewal notices. 
8. Plan the 2027 OBBBA glide path now. Six-month Medicaid redeterminations and work-and-community-engagement requirements take effect in January 2027 for expansion adults. The Urban Institute projects 4.9 to 10.1 million Medicaid coverage losses by 2028. If your practice has a sizable Medicaid panel in an expansion state, build eligibility checks and renewal assistance into your 2027 staffing model in this year's budget. Groups that retain Medicaid-eligible patients through churn will be the ones that staffed for it before the cycle began. 

Join MGMA Stat 

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Notes 

1. Harrop C. "The race for more revenue in medical groups: What's your gameplan?" MGMA. June 18, 2025. https://www.mgma.com/mgma-stat/the-race-for-more-revenue-in-medical-groups-whats-your-gameplan  
2. CMS. "Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)," Oct. 31, 2025. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f 
3. American College of Cardiology. "CMS Releases 2026 Physician Fee Schedule Final Rule," Oct. 31, 2025. https://www.acc.org/Latest-in-Cardiology/Articles/2025/10/31/21/33/cms-releases-2026 
4. Buckhead FMV. "Surgeons and Proceduralists to See Work RVU Decreases Under the 2026 Medicare Physician Fee Schedule," December 2025. https://www.buckheadfmv.com/single-post/surgeons-and-proceduralists-to-see-work-rvu-decreases-under-the-2026-medicare-physician-fee-schedule 
5. Peterson-KFF Health System Tracker. "How much and why ACA Marketplace premiums are going up in 2026," updated January 2026. https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026/ 
6. National Partnership for Women & Families. "What the Decline in ACA 2026 Open Enrollment Means for Women's Progress," March 2026. https://nationalpartnership.org/what-decline-in-aca-2026-open-enrollment-means-for-womens-progress/ 
7. Healthcare Dive. "ACA exchanges will continue to shrink as fewer enrollees pay premiums" (citing Wakely Consulting Group), April 2026. https://www.healthcaredive.com/news/aca-enrollment-2026-premium-effecuation-wakely/817680/ 
8. KFF. "ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments," June 30, 2026. https://www.kff.org/quick-insights/aca-marketplace-enrollment-is-down-by-3-million-after-big-jump-in-premium-payments/ 
9. HFMA. "ACA marketplace enrollment decline puts coverage affordability in focus," June 29, 2026. https://www.hfma.org/payment-reimbursement-and-managed-care/aca-marketplace-enrollment-decline/ 
10. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE). "ACA Exchange Enrollment in 2026," June 26, 2026. https://www.aspe.hhs.gov/sites/default/files/documents/f5f29954221d5b5713070ac2541fda8e/aca-enrollment-report-2026-final-version.pdf 
11. NOTUS. "One in Five HealthCare.gov Enrollees Dropped Insurance Coverage This Year," May 12, 2026. https://www.notus.org/healthcare/aca-healthcare-dropped-insurance-numbers-subsidies 
12. The Hill. "Health insurance marketplace feels growing tremors from GOP cuts," May 2026. https://thehill.com/policy/healthcare/5870619-obamacare-enrollment-decline-gop-cuts/ 
13. Bristol Healthcare Services. "2026 Medicare Premiums and Deductibles Out Now," November 2025. https://www.bristolhcs.com/blog/blog-detail/2026-medicare-premiums-and-deductibles-out-now-key-highlights-and-expert-insights