Key Points:
- Infectious disease (ID) physicians are among the lowest paid of all medical specialties, leading to declining interest among medical students and a national shortage.
- To address this, the Centers for Medicare and Medicaid Services (CMS) introduced a new add-on code increasing payments by ~20% in 2025, the first specialty-specific workforce incentive in the Medicare fee schedule.
- This new analysis offers three recommendations for CMS to guide implementation and evaluation of this new payment model.
Boston, MA – A new analysis by researchers from the Harvard Pilgrim Health Care Institute examines the first Centers for Medicare and Medicaid Services (CMS) add-on code targeting a single physician specialty: infectious disease (ID). The measure is a significant departure from the agency's past strategies, with the potential to combat the growing shortage of ID physicians and broader implications for physician reimbursement and healthcare delivery, according to the authors.
The Viewpoint, "Raising Reimbursement Rates to Combat Specialty Physician Shortages: A New Federal Initiative" was published on June 25 in JAMA.
Despite the vital role ID doctors play in critical public health functions such as pandemic preparedness and antimicrobial stewardship, they are among the lowest paid of all medical specialists. This imbalance between expertise and pay has contributed to a declining interest in the field, leaving half of ID fellowship positions unfilled in 2024. As a result, the U.S. faces a growing shortage of ID physicians, with an uneven distribution that disproportionately affects vulnerable and rural populations.
In response to ID physician discontent, the 2025 Medicare Physician Payment Final Rule included a new add-on code (G0545) for inpatient ID consultations, increasing reimbursement by $28.80 per inpatient ID consultation, an increase of approximately 20% on average over prior compensation levels. The services eligible for the add-on code include disease transmission risk mitigation, public health investigation, analysis and testing, and complex antimicrobial counseling and treatment.
"Infectious disease physicians are at the frontlines managing COVID-19 as well as future pandemics, yet their compensation is within the lowest quartile of all physician compensation," said lead author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. "The add-on code is a meaningful recognition that ID physicians are under-compensated relative to the complexity and intensity of their work, but it remains to be seen whether it will improve ID physician salaries and workforce."
The authors emphasize that, compared to other physician-shortage incentive payment programs, the new ID add-on code does not have a time limit, offers a higher reimbursement increase, and is specialty-specific. They note that while this novel strategy put forth by CMS appears promising, additional steps should be considered while implementing and evaluating the new code. They make three recommendations:
- Ensure the payments translate to increases in physician salary: Efforts are needed to support the complexity of their services rather than the add-on payments being billed by the hospital but not translating to physician salary. For example, CMS could tie payment of the add-on code with transparent reporting from hospitals about ID specialist compensation in their annual cost reports, which are audited by Medicare. This policy lever would be similar to the New Technology Add-on Payment that requires hospital attestation with compliance via Medicare auditing.
- Add location-based incentives: To help alleviate the critical shortage of ID specialists in rural and underserved areas, the add-on code should be extended with a higher reimbursement rate specifically for these areas.
- Treat the ID add-on code as a pilot test: Carefully monitor and evaluate the effectiveness of the add-on code to determine whether it is a viable solution to combat shortfalls in ID specialties before implementing similar measures for other specialties.
The authors note that Medicare's outsized influence on commercial payer fee setting means that the new add-on code has the potential to reset national benchmarks for ID compensation if done effectively. "Medicare is sending a strong signal that Infectious Disease expertise is worth more than our current payment system recognizes," noted Tarun Ramesh, senior author of the study and research fellow at the Harvard Pilgrim Health Care Institute. He adds, "But if hospitals do not pass the bonus through to physicians, shortages in this specialty will continue to adversely affect patient care access and health outcomes."
About the Harvard Pilgrim Health Care Institute's Department of Population Medicine
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