A bipartisan trio of physician-lawmakers on July 15 introduced the Patients First Act, a Medicare payment overhaul aimed at tying physician pay to inflation and bolstering independent practices.
Chairs of the GOP and Democratic Doctors Caucuses — Reps. John Joyce, MD, R-Pa.; Greg Murphy, MD, R-N.C.; and Kim Schrier, MD, D-Wash. — introduced the bill. The proposed legislation is characterized as a comprehensive reform of the Medicare Access and CHIP Reauthorization Act, the 2015 law that repealed the sustainable growth rate formula and created the current quality-payment framework.
The bill arrived one day after CMS on July 14 proposed letting Medicare physician pay fall in 2027 — with base rates dropping 1.19% to $33.17 for clinicians in advanced payment models and 1.68% to $32.84 for all others — positioning the legislation as Congress’ counterweight to the regulatory status quo.
Here are seven details on the bill, which awaits committee action:
1. It ties physician reimbursement to inflation.
The bill would replace the current conversion factor update with the Medicare Economic Index minus 1 percentage point, or MEI-1, according to a section-by-section summary. Guardrails would keep that adjustment from exceeding 0.75 of total MEI or falling below 0.25 in any year.
The alternative payment model conversion factor would grow an additional 0.5 percentage points annually to reward value-based care, and year-to-year variance in the conversion factor would be capped at 2.5%.
2. It creates a primary care hybrid payment pilot.
A five-year demonstration would blend traditional fee-for-service with a per-member-per-month payment for primary care. The per-member-per-month bundle would cover care management, behavioral health integration, office-based evaluation and management services including telehealth, and follow-up communication, with beneficiary cost sharing eliminated on those payments.
Participation would be limited to independent clinicians, who could still bill the fee schedule for services outside the bundle.
3. POINTS would replace MIPS.
After a five-year transition, the bill would rebrand the fee-for-service quality program as the Patient Outcome Improvement National Tabulation System. POINTS would replace the Merit-based Incentive Payment System (MIPS).
A task force composed mostly of clinicians would develop and approve quality metrics, and scoring would be weighted 65% quality, 20% resource use and 15% a new care-efficiency category measuring items such as avoidable hospitalizations and referrals to lower-cost settings.
The proposal sets up a parallel track to CMS’ own plans: the agency’s 2027 proposed rule would sunset traditional MIPS after the 2028 performance year and steer clinicians into MIPS Value Pathways — leaving Congress and CMS pursuing competing overhauls of the same program.
4. It scales back payment penalties.
The MIPS penalty range would drop from plus or minus 9% to plus or minus 2% during the transition, then climb to plus or minus 5% over four years once POINTS takes effect — a structure the bill’s sponsors said is less onerous for small and independent practices.
The bill would also cap bonus payouts for non-independent providers at 50% of the total adjustment and redistribute the remainder to independent clinicians.
5. It freezes APM thresholds and adds guardrails on CMMI.
Qualifying Alternative Payment Model participation thresholds would freeze for three years, with the HHS secretary given flexibility to lower them further.
The bill would also require formal notice-and-comment periods before the Center for Medicare and Medicaid Innovation launches a mandatory model or ends one early, and would direct a report to Congress on barriers to specialty participation in value-based care.
6. It raises the budget-neutrality threshold, though estimates vary.
The bill would lift the threshold that triggers fee-schedule cuts from its current $20 million. A news release from Dr. Joyce’s office puts the new figure at $54.3 million; the section-by-section summary lists $57.64 million and indexes it to MEI every five years.
7. The bill is framed around consolidation and a primary care shortage.
Nearly 70% of medical practices are now owned by hospitals or other corporations, and 1 in 10 physicians works for UnitedHealth or an affiliate, according to the lawmakers. They also said less than 5 cents of every Medicare dollar goes to primary care — which accounts for more than half of physician visits — and that more than 100 million Americans lack access to regular primary care.
Industry reactions
Emily Brower, president and CEO of The National Association of Accountable Care Organizations, applauded the representatives for introducing the bill.
“These policies address long-standing challenges that have threatened access to high-quality care for America’s seniors,” Ms. Brower said in a July 15 statement. “Clinicians cannot take a pay cut, and their pay must reflect the ongoing investment required to provide care.”
The American Medical Association’s president, Willie Underwood III, MD, expressed similar praise for the bill in a statement: “Medicare physician payment is broken, and patients are paying the price. With a 33% inflation-adjusted cut to Medicare physician payment since 2001, too many physician practices are struggling to keep their doors open and care for Medicare patients.”
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