On July 12, the Centers for Medicare & Medicaid Services (CMS) announced a plan to combine Medicare paperwork and levels of payment into one form and one flat rate for each office visit with a patient, with the option of filing for an �add-on� payment of $67 for more complex patients. An analysis by the American Medical Association (AMA) of the impact by Medicare specialty of the proposed E/M changes can be viewed at https://www.cmadocs.org/Portals/CMA/files/News%20Attachments/medicare-2019-pfs-em-impact-analysis.pdf . Other proposals include geographic payment updates for California physicians , a proposal sponsored by the California Medical Association (CMA), and reductions in MIPS reporting burdens. The comment period for the proposed rule ends on September 10. To submit a comment, go to http:// www.regulations.gov , type �CMS-1693-P� in the Search box, and click the Comment Now button on the next screen. To read more about the CMS proposed measures, go to https://www.cmadocs.org/newsroom/news/view/ArticleId/27802/CMA-AMA-responding-to-proposed-Medicare-payment-rule .