LUGPA Policy Alert – House Health Subcommittee Examines Medicare Physician Payment Reform

October 2026

At a Glance

What Happened:
In September, the House Energy & Commerce Health Subcommittee held a legislative hearing examining proposals to address Medicare provider payment challenges and strengthen health care cybersecurity. Members and witnesses discussed several bills relevant to Medicare physician payment, including proposals addressing payment updates, budget neutrality, MIPS, practice expense data, claims data, and payment for office-based procedures.

The hearing featured discussion of the Patients First Act (H.R. 9693), Provider Reimbursement Stability Act (H.R. 8163), Medicare Physician Data-Driven Performance Payment System Act (H.R. 8622), and Promoting Fairness for Medicare Providers Act (H.R. 7863), among other legislation.

Why It Matters:
The hearing demonstrated continued congressional attention to the structure and stability of Medicare physician payment. Members and witnesses discussed the effects of payment instability, inflationary updates, budget neutrality, administrative burden, and MIPS on physician practices and patient access.

The discussion also directly addressed differences in Medicare payment across care settings. H.R. 7863, for example, would address payment for certain procedures involving high-cost supplies furnished in physician offices, an issue directly relevant to specialties that provide resource-intensive care outside the hospital setting.

What’s Next:
LUGPA will continue monitoring the legislation and committee activity as Congress considers potential Medicare payment reforms.

Key Bills

H.R. 9693 – Patients First Act
Would make changes to Medicare physician payment updates and budget neutrality. During the hearing, members and witnesses discussed the need for greater payment stability, inflationary updates, and changes to the current physician payment framework.

Witnesses also discussed the effects of payment instability on practice operations, workforce recruitment, and access to care. Several members described the legislation as a potential step toward addressing longstanding challenges in the Medicare physician fee schedule.

H.R. 8163 – Provider Reimbursement Stability Act
The Provider Reimbursement Stability Act would make several changes to the Medicare physician fee schedule, including raising the budget neutrality threshold, improving reconciliation of estimated and actual utilization, updating direct practice expense data, and limiting certain conversion factor changes attributable to budget neutrality.

The bill was highlighted during the hearing as part of broader efforts to improve predictability in Medicare physician payment.

H.R. 8622 – Medicare Physician Data-driven Performance Payment System Act
The Medicare Physician Data-Driven Performance Payment System Act would make changes to MIPS, including the program's performance threshold and payment structure. It also addresses access to timely performance and claims data.

During the hearing, witnesses discussed concerns with the current MIPS framework, including the importance of specialty-specific measures, physician involvement in measure development, and reliable data for evaluating performance.

H.R. 7863 – Promoting Fairness for Medicare Providers Act
The Promoting Fairness for Medicare Providers Act would modify Medicare payment for certain surgical procedures involving high-cost supplies furnished in physician offices.

During the hearing, Rep. Gus Bilirakis (R-FL) described the legislation as a targeted approach for a narrow group of procedures, under which qualifying physician offices would receive 90% of the corresponding ASC payment. Rep. Raul Ruiz (D-CA) also highlighted differences in reimbursement across care settings and the potential effect on where procedures are provided.

The discussion is particularly relevant to specialties that provide resource-intensive procedures in physician offices and other non-hospital settings.

Other Issues

The hearing also addressed appropriate-use criteria, Medicare claims data, pharmacist services, kidney care, remote patient monitoring, rural health, and health care cybersecurity.

Cybersecurity testimony focused on challenges facing resource-constrained providers, including rural hospitals, and the need for additional resources, training, and preparedness to respond to cyberattacks.

LUGPA Perspective

LUGPA supports efforts to improve the stability and predictability of Medicare physician payment and modernize payment policies to better reflect the cost of providing care.

The hearing's focus on payment stability, budget neutrality, MIPS, practice expense data, and payment differences across care settings reflects several issues that directly affect independent urology practices. Policies should recognize the resources required to deliver care in physician offices and avoid creating payment incentives that disadvantage community-based care.

LUGPA will continue engaging with Congress and monitoring these proposals as they move forward, with a focus on sustainable Medicare payment, independent urology practices, and patient access to community-based care.