What to Know
- ACOG and AMA’s 2027 maternity coding changes will replace global obstetrics codes with an unbundled methodology, creating potential downstream effects on productivity-based compensation.
- Organizations should model the impact now, evaluate attribution across the full care team, and consider temporary compensation protections during the transition.
- Benchmarking, payer strategy, billing operations, and governance will need close monitoring as the new methodology takes effect.
NOTE:
ECG is closely monitoring emerging information on the OB billing change. As of mid-July, CMS is seeking comments on the most effective implementation process. The draft fee schedule has put forward G-codes in place of the existing global codes. While the final rule will not be available until December, we believe the ACOG-recommended principles related to the change remain valid and will be implemented eventually, though potentially delayed. Either way, organizations should have a proactive transition plan that models potential impacts on compensation or productivity and considers the associated operational implications.
Based on the collaborative effort between the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association, effective January 1, 2027, obstetric “global” or “bundled” maternity CPT codes will be discontinued and replaced with new requirements for infant delivery and antepartum/postpartum care. While details about how health plans will operationalize this transition are not fully known, the implications for clinicians’ productivity and corresponding compensation could be significant.
The intent of the forthcoming changes is multifaceted but primarily aims to align coding practices and crediting with contemporary team-based, patient-centered maternity care delivered across multiple clinicians, varied care settings, tailored visit schedules, and a range of patient needs and acuity. While specifics are not finalized, refinements to maternity care coding are imminent with the release of the proposed Medicare Physician Fee Schedule in June or July 2027. Further, ACOG is recommending organizations begin documenting services under the new unbundled methodology starting in September 2026.
Changes of this magnitude often result in anxiety among clinicians due to the subsequent adjustments required to organizations’ compensation structures, operations, and payer strategy/contracting; however, when managed successfully, they can serve as an impetus for system-wide improvements related to access and team-based care delivery.
Below are three tips to help system leaders navigate the potential compensation-related implications.
1. Test your current compensation attribution and methodologies.
Many medical groups’ and integrated health systems’ OB/GYN physicians will not see a material change to compensation under the proposed billing updates because of existing pools or attribution methodologies that occur in the background of compensation administration processes. However, organizations that do not pool or individually attribute the existing global code could see significant changes in productivity-driven clinical compensation plans.
To maintain a competitive compensation structure that supports recruitment and retention, these organizations should “shadow model” current production by removing deleted codes and applying the new unbundled methodology based on existing documentation and assumptions.
For all organizations, regardless of their current compensation methodology, it is important to understand any potential implications across the care team, including both employed and contracted OB/GYN physicians, midwives, OB/GYN APPs, and OB hospitalists. Without appropriate design considerations, these changes could contribute to internal competition for specific patients or deliveries.
2. Consider a protection period for clinical compensation.
Because this is an impending change with implications not yet fully understood, it may be helpful to establish compensation protections for any variable OB pay within existing care teams to build trust during the transition and support provider retention. These protective measures could include floors or shadow reporting periods that compare the historical and current models and generate a “greater of” output for a defined period. It is important to note that these protections should apply to any clinicians with variable OB pay, including WRVUs, delivery crediting, or call pay distributions.
3. Be prepared for clinical production benchmarks to shift, but not immediately.
With the forced adjustments to attribution, it will likely take two years for market benchmarks to reflect the OB global changes. While CMS intends for the overall count of WRVUs to be maintained through the new unbundled methodology, there will likely be movement in benchmark WRVU data among OB/GYN physicians, midwives, OB/GYN APPs, and OB hospitalists.
Each of these changes will be driven by WRVU data that is more individually attributed and better reflective of any acuity considerations. In response, organizations should closely evaluate any individual or specialty thresholds on an internal basis to ensure total spending on compensation does not shift dramatically. If there is not already one in place, this may be a good reason to evaluate an incentive pool to limit any internal competition or consider the previously mentioned protection period.
Looking Ahead
As with any substantial changes, organizations should ensure a governance process is in place to set forth a plan of action. Early alignment among key stakeholders such as physician leadership, operations, revenue cycle, contracting, compensation, and compliance will ensure a response that is most appropriate for your organization.
And while compensation will likely be the first area organizations hear about major concerns associated with these changes, the effects on operations and billing are projected to be even more substantial.
Keep an eye out for forthcoming blog posts where our experts break down these potential operational and payer implications in more detail.
