Medicine is about to lose its humanity in 2026

She arrived ten minutes early, already tired. A thick packet of paperwork rested in her lap, filled with questions she had answered last year and the year before — her medications, surgeries, daily function, memory, ability to cook, clean, shop, dress, and bathe. She had to remember three unrelated words and draw a clock. She had to rewrite her family history, even though none of it had changed.

This had to be completed before I walked through the door — not because it would improve her care, but because the visit would not count if anything was left blank. By the time I sat down, her appointment had become an exam.

Patients tell me this all the time. Their annual wellness visit feels intrusive and repetitive. What they cannot see is that the packet is only one symptom of something worse.

Right now, in the final weeks of 2025, health systems across the country are rewriting their 2026 workflows because CMS and Medicare Advantage plans are finalizing next year’s quality thresholds. Electronic medical records are updating with new mandatory fields, prompts, and alerts. In 2026, missing early performance targets will carry consequences that cannot easily be reversed. Medicare Advantage plans have already built these thresholds into their 2026 Star Ratings projections, which means systems must act as if the rules are final. Operationally, 2026 is locked in.

This is not the usual year-end revision but a fundamental shift — the most consequential in more than a decade.

The measures my department is responsible for next year look nothing like what we were judged on even 12 months ago. Quality programs tied directly to Medicare Advantage Star Ratings — and the reimbursements linked to them — have been elevated to the highest priority. Our 2026 model increases the number of measurements, expands what counts toward value-based bonuses, and places heavier weight on clinician-dependent items such as annual care visits, diabetes control, kidney evaluations, statin use, medication adherence, and cancer screening.

Entire protocols have been rebuilt to meet these requirements. Measures that barely mattered last year now determine staffing, scheduling, documentation, and resources. For the first time in my career, I am watching care pathways redesigned before a year even begins, built not around patient needs but rather around a scoring system.

What makes 2026 different is the combination of higher thresholds, stricter scoring, and elimination of the flexibility clinicians once relied on. Cut points for statin adherence, diabetes control, blood pressure, cancer screening, and preventive care are all rising — in some cases by double digits. Many plans have already warned that achieving four- and five-star performance in 2026 will require “dramatically higher closure rates.” A clinic delivering the exact same care in 2025 may fall to 3 Stars next year without changing a single thing. That has never happened at this scale.

Also, several measures previously considered “reporting only” now fully count toward Star Ratings and reimbursements. CMS has been phasing these in over years, but 2026 is the first time they carry full financial weight. The buffer clinicians once had is gone. What was recorded is now graded.

And the rigidity extends further. A patient may have completed a mammogram or colonoscopy elsewhere, but if the documentation never reaches my chart, it counts as a failure — even when the screening was done exactly as recommended. The same applies to diabetes. An A1C above 9 percent is automatically marked against the clinician and the system. Yes, well-controlled diabetes should generally fall below that threshold. But there are countless reasons it may not: the cost of insulin, food insecurity, low health literacy, transportation barriers, depression, or simple life-overwhelm. None of these matter to the scorecard. The number alone determines success or failure, and in 2026 the penalty attached to that number is larger than ever.

Meanwhile, the narrowest part of the system will be unchanged: the exclusions. For measures like statin adherence, a clinician can document allergy, severe adverse reaction, or terminal illness. That is it. There is no exclusion for a competent adult who declines a medication after a thoughtful, informed conversation. No quality program in the country recognizes informed refusal as a valid clinical outcome. In years past, this created frustration. In 2026, it creates penalties. That is the difference. Last year nudged clinicians. Next year punishes them.

Consider the statin requirement. A patient must fill the medication twice in a calendar year. If a 76-year-old declines, it counts as a failure — and next year the cost of that failure rises sharply. Clinicians who honor autonomy will thus miss metrics. Clinicians who push pills to protect their score will meet metrics.

Physicians are being asked to choose between honoring patients’ values and protecting their organizations from financial harm — an impossible moral conflict no metric can reconcile.

The annual wellness visit exposes this misalignment. Created to promote prevention, it has expanded into a checklist. In many systems — including my own — the 2026 annual visit requirements have grown significantly, filled with mandatory fields that reflect the new scoring structure rather than any new clinical necessity.

Patients find it overwhelming; physicians find it detached from the concerns that bring people into the room. And the more the visit expands to meet new requirements, the less time for the conversation the patient actually came to have. We are mistaking documentation for care and compliance for quality.

Congress and CMS can still do something about this. CMS still has a narrow window — days, not weeks — to correct the most damaging flaw in the reporting: The absence of an autonomy exclusion across quality measures. The fix is straightforward: allow clinicians to document when patients decline recommended treatments after an informed discussion. Nothing about this lowers standards.

We can build a system that rewards compliance, or we can build one that respects people. We cannot build both. What we decide in 2026 will determine whether medicine remains a human profession or a compliance industry disguised as care.

Ryan Nadelson, MD, is chair of internal medicine at Northside Hospital Diagnostic Clinic in Gainesville, Ga.