A bipartisan group of physician members of Congress has introduced comprehensive legislation aimed at reforming the Medicare physician payment system, strengthening independent medical practices, and improving patients’ access to affordable healthcare.
On July 15, 2026, Representatives John Joyce, MD, Greg Murphy, MD, and Kim Schrier, MD, introduced the Patients First Act, a proposal designed to modernize the Medicare Access and CHIP Reauthorization Act and address growing concerns surrounding physician reimbursement, healthcare consolidation, administrative burden, and access to primary care.
The three lawmakers serve as chairs of the Republican and Democratic Doctors Caucuses and bring direct clinical experience to the effort. The legislation focuses on creating greater financial stability for physician practices while encouraging competition and maintaining access to community-based care, particularly in rural and underserved areas.
A Payment System Under Increasing Pressure
The Medicare Access and CHIP Reauthorization Act of 2015, commonly known as MACRA, replaced the sustainable growth rate formula previously used to determine updates to the Medicare Physician Fee Schedule.
MACRA also established the Merit-based Incentive Payment System, consolidated several physician incentive programs, and promoted participation in alternative payment models. However, the lawmakers behind the Patients First Act argue that the current framework has not adequately responded to rising practice expenses, workforce pressures, and the changing structure of the healthcare system.
Representative Joyce said the medical community is facing a critical decision over whether to maintain the current system or build a more modern framework that better supports physicians and patients.
“We often talk about expanding access to high-quality care, but without meaningful Medicare reimbursement reform, that mission becomes nearly impossible to achieve,” Joyce said.
He emphasized that the future of patient care, the strength of the physician workforce, and the survival of independent practices may depend on whether Congress acts to reform the existing payment structure.
Protecting Independent Medical Practices
A central goal of the legislation is to strengthen independent physician practices, which lawmakers say are increasingly vulnerable to low reimbursement rates, rising operating costs, and administrative requirements.
According to background information included in the announcement, nearly 70% of medical practices across the United States are now owned by hospitals or other corporations. The release also states that approximately one in 10 physicians works for UnitedHealth or one of its affiliated organizations.
The legislation’s sponsors argue that when independent practices can no longer remain financially sustainable, physicians may be forced to close their offices or sell to larger healthcare systems and corporate entities. They warn that such consolidation can reduce competition, limit patient choice, and contribute to higher healthcare costs.
Representative Murphy, who has practiced as a urologist for more than 30 years, said the current Medicare physician payment system has become unsustainable.
“It has fueled consolidation, increased administrative burdens, and made it harder for independent physicians in rural communities to continue serving the patients who rely on them,” Murphy said.
He added that the Patients First Act is intended to give physicians more time to care for patients by reducing the burden associated with complex administrative processes.
Reimbursement Linked to Inflation
One of the most significant provisions of the Patients First Act would link physician reimbursement to an inflationary measure.
Physician organizations have repeatedly raised concerns that Medicare payment updates have not kept pace with the increasing cost of operating medical practices. Expenses related to staffing, medical supplies, technology, regulatory compliance, and facility operations have continued to rise, while physician reimbursement has faced repeated reductions or limited adjustments.
By connecting reimbursement to inflation, the legislation seeks to provide greater predictability and stability for practices participating in Medicare.
Supporters believe this change could help independent physicians maintain their practices, invest in staff and infrastructure, and continue accepting Medicare patients.
A New Investment in Primary Care
The Patients First Act also addresses what its sponsors describe as a national primary care crisis.
Primary care physicians play a central role in prevention, early diagnosis, chronic disease management, treatment coordination, and long-term patient care. However, the legislation’s background materials state that less than five cents of every Medicare dollar is directed toward primary care, despite primary care accounting for more than half of physician visits.
The release also notes that more than 100 million Americans do not have access to regular primary care.
Representative Schrier warned that failure to reform the system could result in further practice closures, rising costs, and reduced access for patients.
“Consolidation in our healthcare system is forcing small, independent physicians to sell their practices to corporate entities, decreasing choice and competition, and increasing costs for patients without delivering better quality,” Schrier said.
She described the legislation as a bipartisan approach to providing stability for independent practices, reducing paperwork, and strengthening investment in primary care.
A Hybrid Payment Pilot for Primary Care Physicians
To better reflect the scope of services provided by primary care clinicians, the legislation would establish a primary care hybrid payment pilot program.
Under the proposed model, participating primary care providers would receive a per-member-per-month payment alongside payments for regular medical services.
The model is intended to recognize work that may not be fully captured through traditional fee-for-service billing. This can include care coordination, communication with patients, preventive health planning, chronic disease monitoring, and collaboration with specialists and other members of the healthcare team.
The hybrid structure would aim to provide primary care practices with more consistent financial support while maintaining payment for services delivered during patient visits.
Reducing Administrative Burden Through the POINTS Program
The legislation would also establish the POINTS program, which would create a physician- and clinician-led task force within the Centers for Medicare & Medicaid Services.
The task force would be responsible for developing streamlined quality measures and identifying opportunities to reduce administrative burden.
Quality reporting requirements have become a major concern for many medical practices, particularly smaller organizations with limited administrative staff. Physicians may be required to devote substantial time and resources to documentation, reporting, compliance, and performance measurement.
By involving physicians and clinicians directly in the development of quality metrics, the POINTS program is intended to ensure that measures are clinically meaningful, practical, and less burdensome.
Changes to Alternative Payment Models
The Patients First Act includes several provisions related to alternative payment models and the Center for Medicare and Medicaid Innovation.
The proposal would freeze participation thresholds for advanced alternative payment models for three years. It would also establish notice-and-comment periods for mandatory models introduced by the Center for Medicare and Medicaid Innovation.
These measures are designed to provide physicians and healthcare organizations with greater predictability when participating in new payment arrangements and care delivery models.
The legislation would additionally increase the budget neutrality threshold from $20 million to $54.3 million.
A Bipartisan Effort Focused on Access
The Patients First Act brings together lawmakers from both parties around a shared concern: whether the current Medicare payment system can continue to support accessible, community-based physician care.
Its sponsors argue that reform is necessary not only to protect medical practices, but also to preserve patient choice, strengthen competition, and ensure that older adults and patients in underserved communities can continue to receive care close to home.
The proposal now enters the congressional process, where its provisions will be reviewed and considered by lawmakers.
For physicians, patients, and healthcare organizations, the legislation represents a significant attempt to revisit the structure created under MACRA and establish a Medicare payment framework that more closely reflects current economic and clinical realities.
Written by Nare Hovhannisyan, MD
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