Congress Just Proposed the Biggest Rewrite of Medicare Physician Pay in a Decade. Here’s What Practice Managers Actually Need to Do About It

Three physician lawmakers introduced a bill on July 15, 2026, that could reshape the financial foundation of Medicare physician payment. That’s not just a policy proposal on paper — H.R. 9693, the Patients First Act of 2026, would make structural changes to how Medicare physician payment is updated and redistributed. And if you run a practice, bill for Part B services, or advise physicians who do, this is the piece of legislation to actually read this year, not just skim in a newsletter.

Here’s the version of this story that matters for people who manage budgets, not just people who write policy briefs.

The Number that Explains Everything

Start with the fact that makes this bill politically possible in a divided Congress: adjusted for inflation in practice costs, Medicare physician payment has fallen approximately 33% since 2001, according to figures the American Medical Association compiles from the Federal Register, the Medicare Trustees’ Reports, the Bureau of Labor Statistics, and the Congressional Budget Office. Over that same period, practice costs rose by roughly 59%, according to AMA estimates. Put those two lines on a chart and you get a scissors graph that every practice administrator has felt in their staffing budget, their EHR contract, and their malpractice premium — even if they’ve never seen the AMA’s version of it.

This isn’t a one-year anomaly. 2026 marked another year of downward pressure on Medicare physician payment, following several consecutive years of payment reductions, and the Medicare Payment Advisory Commission (MedPAC), Congress’s independent advisory body, has repeatedly called for structural changes to Medicare physician payment rather than relying on short-term fixes. That’s the backdrop the Patients First Act was written against.

Who Actually Wrote this, and Why Bipartisan Matters Here

The bill comes from the co-chairs of the Congressional GOP and Democratic Doctors Caucuses: Reps. John Joyce, M.D. (R-PA-13), Greg Murphy, M.D., FACS (R-NC-03), and Kim Schrier, M.D. (D-WA-08). All three are physicians with clinical backgrounds — Joyce is a dermatologist, Murphy is a urologist, and Schrier is a pediatrician, respectively — which is worth noting because the bill reads less like a lobbyist wish list and more like a document written by people who have personally sat across from a Medicare patient while doing the reimbursement math in their head.

As of this writing, the bill has more than 20 cosponsors and has been formally endorsed by the American College of Physicians, the American Society of Anesthesiologists, and — with real reservations, which we’ll get to — the American College of Surgeons. That range of support, from a primary-care-heavy society to a procedural specialty society, is itself a signal: this bill is trying to thread a needle that has broken previous reform attempts, which usually help one type of practice at the direct expense of another.

What the Bill Actually Changes — Not the Press-Release Version

Skip the talking points. Here’s what’s in the text that was filed with Congress.

1. Annual inflation-indexed updates. The bill ties the yearly update to physician payment to the Medicare Economic Index (MEI), the same inflation measure MedPAC has been pushing Congress to adopt. This replaces the current system, where Congress has to intervene almost every year with a temporary patch to prevent scheduled cuts — the “doc fix” cycle that has defined Medicare payment policy since the Sustainable Growth Rate era.

2. A higher budget-neutrality trigger. This is the most technical provision and arguably the most consequential one for your bottom line. Current law requires an automatic, across-the-board payment adjustment whenever CMS projects that fee schedule changes will shift Medicare spending by more than $20 million in a year — a threshold set decades ago that hasn’t been adjusted for the actual size of Medicare spending since. In practice, this tiny trigger is why a coding change or a new service added for one specialty routinely produces a conversion-factor cut that lands on every other specialty. The bill raises that threshold and, per the bill text filed with Congress, changes how the dollar amount is calculated going forward. It also directs correction mechanisms when CMS’s utilization estimates for new or revised codes turn out to be wrong — a response to concerns highlighted by the G2211 experience, in which CMS’s projected utilization of the complexity add-on code was substantially higher than subsequent claims data, contributing to a broader budget-neutrality adjustment.

3. MIPS gets renamed and reworked — not eliminated. The Merit-based Incentive Payment System becomes “POINTS” under the bill, with a stated goal of giving physicians and specialty societies a greater role in developing clinically relevant, specialty-specific quality measures, while preserving existing low-volume exemptions and the role of Qualified Clinical Data Registries. If your practice has spent years wrestling with generic MIPS measures that don’t map cleanly onto your specialty, this is the provision to watch — but “rename and redesign” is a long way from “simplify,” and the bill leaves much of the operational detail to future rulemaking.

4. A primary-care hybrid payment pilot (2027–2031). This is a five-year demonstration, not a permanent policy change, so don’t build a five-year staffing plan around it yet. Under the pilot, eligible primary care practices would receive a per-member-per-month payment layered on top of standard fee-for-service billing, intended to compensate for care coordination, chronic disease management, and communication work that current E/M codes routinely undercount. The AMA describes the demonstration as a fully funded five-year hybrid payment model for independent primary care practices.

5. Quarterly, published geographic adjustments. Starting January 1, 2027, Medicare administrative contractors would be required to publish geographically adjusted work relative value units on a quarterly basis, covering geographic practice cost adjustments — a transparency requirement that should, in theory, make it easier for multi-state and rural practices to forecast revenue rather than wait for the annual fee schedule release.

6. A mandated look at specialty access to value-based care. By December 31, 2029, the Government Accountability Office, working with MedPAC, must report to the relevant House and Senate committees on the specific barriers keeping specialty providers out of Alternative Payment Models, with concrete policy recommendations attached — a provision aimed at surgical and procedural specialties that have historically had fewer APM options than primary care.

Read the Pushback, Not Just the Applause

The endorsements are genuine, but so is the specialty-society skepticism, and a good practice manager should weigh both. The American College of Surgeons called the bill “meaningful progress” while stating plainly that it “remains insufficient for surgeons” — a reminder that a primary-care-weighted hybrid payment pilot and an MEI-based update don’t automatically solve the practice-expense and global-surgical-package issues that procedural specialties have raised for years. If your practice leans surgical or procedural, don’t assume this bill solves your specific reimbursement pressure points; read the fee schedule provisions with your own specialty’s RVU mix in mind, not the headline.

What this Actually Means for Your Practice, This Year

Nothing in H.R. 9693 changes your 2026 or 2027 billing yet. It’s a bill, not law — introduced with more than 20 cosponsors, not yet marked up in committee. Treat everything below as planning intelligence, not a done deal.

Model both scenarios. Run your 2027 projections two ways: current-law fee schedule (which still includes annual budget-neutrality risk) and an MEI-indexed scenario. The gap between them is the number to bring to your next partner or hospital-system budget meeting.

If you’re primary care, look hard at the hybrid pilot. A five-year per-member-per-month demonstration is a real operational shift — it changes how you’d staff care coordination and how you’d measure practice profitability per patient panel, not per visit. Start the conversation with your billing and clinical teams now, before an application window exists.

Watch the MIPS-to-POINTS transition closely. Specialty societies will get a greater role in designing new measures. If your specialty society hasn’t already solicited member input on this, ask them to — this is the moment measure sets actually get written, not after the rule is finalized.

Track the G2211 correction mechanism as a leading indicator. How CMS handles utilization-estimate corrections under this bill (if it passes) will tell you a lot about whether the budget-neutrality reforms have real teeth or are mostly procedural.

Don’t overweight the geographic-adjustment transparency provision, but don’t ignore it either. Quarterly published data is a genuine forecasting upgrade for multi-site and rural practices — worth building into your finance team’s reporting cadence once (and if) it takes effect.

The Honest Bottom Line

Medicare physician payment reform bills get introduced almost every Congress and most die quietly in committee. What makes the Patients First Act worth actually tracking — rather than filing under “aspirational” — is the combination of physician-authored bipartisan sponsorship, early buy-in from societies representing both primary care and specialty medicine, and a direct, textual response to the exact mechanism (the $20 million budget-neutrality trigger) that practice managers have been complaining about for years. That doesn’t guarantee passage. It does mean this is a significant Medicare payment reform proposal led by physician lawmakers with direct clinical experience — which is exactly why it deserves a real read, not just a headline scan.

Sources

1. American Medical Association, “Medicare physician pay has plummeted since 2001. Find out why.” — ama-assn.org
2. American Medical Association, “2025 Medicare updates compared to inflation” (chart/PDF) — ama-assn.org
3. American Medical Association, “Overestimate tripled budget-neutrality Medicare physician pay cut” — ama-assn.org
4. American Medical Association, “Medicare experts back tying physician payment to inflation” — ama-assn.org
5. Congress.gov, “H.R.9693 – Patients First Act of 2026,” 119th Congress, full bill text — congress.gov
6. Office of Rep. Kim Schrier, “Drs. Schrier, Joyce, and Murphy Introduce Bipartisan Patients First Act” — schrier.house.gov
7. American College of Physicians, “ACP Supports the Patients First Act of 2026, H.R. 9693” (letter) — acponline.org
8. American College of Surgeons, “Bipartisan Medicare Payment Reform Bill Is Introduced,” ACS Brief — facs.org
9. American Society of Anesthesiologists, “ASA Lauds Bipartisan Doc Caucuses’ Medicare Physician Payment Reform Bill” via Newswise — newswise.com
10. Infectious Diseases Society of America, “Patients First Act aims to reform physician reimbursement” — idsociety.org
11. Quiver Quantitative, “New Bill: Representative John Joyce introduces H.R. 9693: Patients First Act of 2026” (bill summary) — quiverquant.com
12. Michigan State Medical Society, “Bipartisan Medicare Reform Legislation Introduced” — msms.org
13. OncoDaily, “Bipartisan Patients First Act Seeks Major Reform of Medicare Physician Payments” — oncodaily.com
14. Medical Economics, “MedPAC: Increase physician pay by 0.5% for 2027” — medicaleconomics.com
15. Medical Economics, “2026 Medicare reimbursement: ‘Inadequate physician payment has real-world consequences,’ AMA says” — medicaleconomics.com
16. American Academy of Family Physicians, “Physician payment updates aren’t keeping up with inflation: a solution” — aafp.org
17. Fix Medicare Now (AMA campaign site), “History of Medicare Payment Reform” timeline — fixmedicarenow.org