What's Happening?
Representative Kim Schrier, a Democrat from Washington, has co-sponsored the bipartisan Patients First Act of 2026 (H.R. 9693), a comprehensive piece of legislation aimed at reforming Medicare physician payment. The bill, introduced by Reps. John Joyce,
MD (R-Pa.), Kim Schrier, MD (D-Wash.), and Greg Murphy, MD (R-N.C.), seeks to address the long-standing issue of declining Medicare physician payments, which have fallen approximately 33% since 2001 when adjusted for inflation. The Patients First Act proposes to replace the current Merit-based Incentive Payment System (MIPS) with a new quality measure program called POINTS (Patient Outcome Improvement National Tabulation System) over a four-year transition period. This new system would reduce reporting burdens for physicians and cap payment penalties at a maximum of 5% after a transition period, significantly lower than the current negative 9% under MIPS. The legislation also includes provisions for automatic, annual inflation-based payment updates and modernizes budget-neutrality policies to ensure financial stability for physicians.
Why It's Important?
The Patients First Act is crucial for the sustainability of the U.S. healthcare system, particularly for independent and rural physician practices. The current Medicare payment system, specifically MIPS, has been criticized for its burdensome reporting requirements and disproportionately penalizing small and rural practices. The proposed reforms aim to shift the focus from administrative activities to value-based care, allowing physicians to dedicate more time to patient care. By establishing automatic, inflation-based payment updates, the bill seeks to ensure that physician payments keep pace with rising practice costs, including staffing, technology, and regulatory compliance. This financial stability is vital for maintaining access to high-quality care for Medicare beneficiaries, especially in underserved areas where small and independent practices are often the primary providers. The legislation's emphasis on physician input in quality measure development through a clinician-majority Quality Care Reform Task Force is also significant, as it aims to create more clinically relevant and effective metrics.
What's Next?
The Patients First Act, having garnered 50 cosponsors, is currently undergoing legislative review, with the House Energy and Commerce Committee having held a hearing on strengthening the Medicare physician payment system, focusing significantly on this bill. If passed, the legislation would initiate a four-year transition period to replace MIPS with the new POINTS program, starting with reduced MIPS penalties. A five-year demonstration program for primary care physicians in independent practices, featuring a hybrid payment model, is slated to run from 2027 through 2031. The bill also mandates the establishment of a Quality Care Reform Task Force, composed of a clinician majority, to recommend measures for the POINTS program. The Secretary of Health and Human Services would be required to respond to these recommendations and report progress to Congress within 120 days. The AMA is actively urging physicians to contact their representatives to support and cosponsor the Patients First Act.
Beyond the Headlines
Beyond the immediate financial and administrative relief for physicians, the Patients First Act could trigger a broader shift in the philosophy of healthcare delivery within the U.S. By prioritizing patient outcomes and physician input over bureaucratic reporting, the legislation aims to foster a more patient-centered and efficient healthcare environment. The proposed primary care demonstration program, with its hybrid payment model, could serve as a blueprint for future payment reforms, potentially encouraging more integrated and holistic care models that focus on prevention and chronic disease management. Furthermore, the emphasis on clinician-led quality measure development could empower medical professionals to shape the standards of care, potentially leading to more innovative and effective treatment protocols. This legislative effort reflects a growing recognition of the need to address systemic issues in Medicare payment to ensure the long-term viability of physician practices and access to quality care for an aging population.
