Infectious disease (ID) physicians have long been the unsung heroes of modern medicine, managing complex and high-stakes health crises that range from pandemic preparedness to antimicrobial stewardship. Yet, despite their critical role in protecting public health and guiding clinical interventions against some of the most challenging pathogens, these specialists remain among the lowest compensated within the medical profession. This persistent pay disparity has sown the seeds of a growing national shortage, with fewer medical students choosing the ID path, thereby threatening the future availability and quality of infectious disease care across the United States.
Recognizing this alarming trend, the Centers for Medicare and Medicaid Services (CMS) has taken an unprecedented step by introducing the first specialty-specific add-on payment code within the Medicare Physician Fee Schedule. Effective in 2025, this new provision, designated G0545, supplements reimbursement for inpatient infectious disease consultations by approximately 20%, reflecting not only the complexity of ID services but also CMS’s acknowledgment of the urgency to reverse workforce decline. This move marks a pivotal shift in federal health policy, signaling a nuanced understanding that adequate compensation must align with clinical expertise and public health value.
Historically, federal reimbursement models have largely applied across-the-board fee adjustments or broadly targeted specialties with widespread shortages without tailoring incentives to specific disciplines. This new CMS add-on code departs from such conventions by directly tying additional payments to the unique responsibilities handled by ID physicians—ranging from intricate risk mitigation for disease transmission, comprehensive public health investigations, advanced laboratory analysis, to nuanced antimicrobial counseling and treatment strategies. This degree of specificity in reimbursement design could set a transformative precedent for physician payment policy.
Researchers from the Harvard Pilgrim Health Care Institute conducted a rigorous analysis of this novel payment model, published in the June 2025 edition of JAMA. Their work underscores both the promise and the challenges inherent in this pioneering federal initiative. According to the study’s lead investigators, while the increase in reimbursement is substantial relative to historic compensation benchmarks, it remains to be seen whether these add-on payments will effectively translate into enhanced salaries for ID physicians rather than merely bolstering hospital revenue streams. The latter scenario risks failing to address the core disincentive that has deterred entry into the specialty.
Moreover, infectious disease specialists often shoulder responsibilities that extend well beyond direct patient care, including critical roles in antimicrobial stewardship programs that combat antibiotic resistance—a global health threat that births strains of bacteria impervious to existing drugs. They also play an indispensable role in pandemic preparedness and response, their expertise often guiding policy decisions and clinical protocols during outbreaks. Current compensation mechanisms, however, have inadequately reflected these multilayered contributions, fostering a disconnect between the demands of the specialty and the financial rewards it yields.
An additional complicating factor highlighted by the researchers is the geographic maldistribution of infectious disease physicians. Rural and underserved regions suffer disproportionately from shortages, contributing to stark disparities in health outcomes related to infectious diseases. The CMS add-on code, while a critical initial step, does not yet integrate location-sensitive adjustments that could incentivize deployment of ID specialists to these high-need areas. Recognizing this gap, the Harvard Pilgrim team advocates for augmenting the add-on payments with differential rates based on geographic and demographic criteria to strategically steer workforce allocation.
The study also calls for a framework of accountability and transparency to ensure that increased reimbursements meaningfully impact physician income. Hospitals and health systems are currently positioned to bill using the add-on code, yet without explicit mechanisms for verifying that these funds are passed through to the specialists themselves, the intended incentive effect could be diluted. The researchers propose that CMS incorporate auditing and reporting requirements tied to physician compensation, analogous to the practices employed in monitoring New Technology Add-on Payments, fostering trust that financial incentives are properly channeled.
Beyond immediate pay adjustments, the policy architects and researchers alike emphasize the importance of viewing this add-on code as a pilot program—a deliberate experiment subject to careful monitoring, data collection, and outcome evaluation. This iterative approach would help CMS and other stakeholders gauge the efficacy of such targeted reimbursement strategies in mitigating specialty shortages before scaling or adapting the model to other clinician groups facing similar challenges. Metrics such as changes in filled fellowship positions, physician retention, patient access, and health outcomes will be pivotal in this evaluative phase.
The implications of this initiative extend beyond the infectious disease specialty itself. Because Medicare reimbursement rates frequently anchor commercial payer fee setting, an upward adjustment in ID compensation under Medicare has the potential to recalibrate nationwide payment standards. This could signal a broader recalibration of how physician services are valued, particularly in specialties characterized by complex, high-risk clinical work that is not adequately captured by conventional billing codes. The researchers view this as an opportunity to realign financial incentives with contemporary healthcare needs and public health priorities.
While the new add-on code is certainly a promising policy innovation, the Harvard Pilgrim analysis underscores that remedying physician shortages demands a multi-faceted strategy encompassing compensation, workforce distribution, educational support, and systemic recognition of specialty-specific contributions. Only through coordinated policy action, transparency measures, and ongoing assessment can the longstanding undervaluation of infectious disease expertise be effectively reversed, ensuring robust access to specialist care in a landscape defined by emerging infectious threats and evolving healthcare complexities.
As the United States faces an uncertain infectious disease horizon marked by emerging pathogens and persistent antimicrobial resistance, strengthening the infectious disease physician workforce becomes not only a matter of clinical necessity but one of public health and national security. CMS’s add-on payment initiative represents a foundational step in this direction, yet its ultimate success will hinge upon sustained commitment to equitable, targeted reimbursement policy, careful performance evaluation, and responsive adaptation to observed outcomes.
In their concluding remarks, the Harvard Pilgrim team imparts a clear message to policymakers and healthcare leaders: Infectious disease specialists possess unique and indispensable expertise that justifies higher compensation commensurate with their impact on patient care and population health. However, translating reimbursement policy changes into tangible improvements in workforce stability and patient health outcomes requires vigilant implementation and accountability. Without this, the ongoing shortage will persist, undermining the healthcare system’s capacity to respond adeptly to infectious disease challenges.
This novel federal reimbursement strategy thus stands at a crossroads, with the potential to reconfigure how specialized medical expertise is recognized and rewarded within the U.S. health system. Its trajectory will be closely watched by clinicians, hospital administrators, and policymakers alike, as it may herald a new era in tailored physician payment reforms designed to sustain critical specialties integral to the health security of the nation.
Subject of Research: Infectious Disease Physician Workforce and Medicare Reimbursement Policy
Article Title: Raising Reimbursement Rates to Combat Specialty Physician Shortages: A New Federal Initiative
News Publication Date: 25-Jun-2025
Web References: Harvard Pilgrim Health Care Institute Department of Population Medicine
References: Yu, H., Ramesh, T., et al. (2025). Raising Reimbursement Rates to Combat Specialty Physician Shortages: A New Federal Initiative. JAMA, June 25, 2025.
Keywords: Health care policy, Health care costs, Health care delivery, Insurance, Public finance, Clinical medicine, Infectious diseases, Health and medicine
