LUGPA Policy Brief - Patients First Act Would Deliver Comprehensive Medicare Physician Payment Reform

July 2026

At-a-Glance

What's Happening

Representatives John Joyce, M.D. (R-PA), Greg Murphy, M.D. (R-NC), and Kim Schrier, M.D. (D-WA) have introduced the Patients First Act, comprehensive legislation to modernize the Medicare physician payment system established under the Medicare Access and CHIP Reauthorization Act (MACRA). The legislation seeks to stabilize physician reimbursement, strengthen independent medical practices, reduce administrative burdens, encourage value-based care, and improve access to healthcare for Medicare beneficiaries.

Why It Matters

For more than two decades, Medicare physician reimbursement has failed to keep pace with inflation while physician practices have experienced rising staffing, technology, and operating costs. These payment shortfalls have accelerated physician practice consolidation, reduced competition, and threatened patient access to community-based specialty care.

Independent urology practices have been particularly affected by repeated Medicare payment reductions, increasing reporting requirements, and budget neutrality adjustments that create unpredictable reimbursement from year to year.

The Patients First Act represents one of the most comprehensive bipartisan efforts to reform Medicare physician payment since MACRA was enacted in 2015.

Key Provisions

Provides Predictable Medicare Payment Updates

• Replaces the current physician payment update formula with annual updates tied to the Medicare Economic Index (MEI), providing physicians with inflation-based payment increases while maintaining budgetary guardrails.
• Preserves higher conversion factor updates for Advanced Alternative Payment Model (A-APM) participants to encourage value-based care.

Reduces Administrative Burden

• Replaces the current Merit-based Incentive Payment System (MIPS) with a new physician-led quality program known as POINTS (Patient Outcome Improvement National Tabulation System).
• Creates a clinician-majority Quality Reform Task Force responsible for developing practical, evidence-based quality measures.
• Reduces MIPS penalties during the transition period and lowers the maximum payment adjustment under the new system from ±9 percent to ±5 percent.
• Expands the role of Qualified Clinical Data Registries (QCDRs) in developing and reporting specialty-specific quality measures.

Supports Independent Physician Practices

• Creates bonus opportunities specifically for high-performing independent physician practices.
• Limits quality incentive payments available to large non-independent providers, directing more resources toward independent practices.
• Requires CMS to report annually on physician payment adequacy, beneficiary access, and physician practice consolidation.

Improves Medicare Payment Stability

• Raises the budget neutrality threshold from $20 million to approximately $57.6 million (indexed over time), reducing the frequency of across-the-board payment cuts resulting from relatively small coding changes.
• Limits annual conversion factor fluctuations to improve payment predictability.
• Requires more frequent updates to practice expense inputs to better reflect the actual costs of providing care.

Strengthens Value-Based Care

• Freezes A-APM participation thresholds for three years.
• Requires notice-and-comment rulemaking before mandatory CMMI payment models are implemented.
• Directs GAO, CMS, and MedPAC to identify barriers preventing specialists from participating in value-based payment models.

LUGPA Position

LUGPA strongly supports comprehensive Medicare physician payment reform that preserves independent physician practices and ensures patients continue to have access to high-quality, community-based urologic care.

The Patients First Act addresses many of LUGPA's longstanding advocacy priorities by:

• Establishing predictable, inflation-based Medicare physician payment updates.
• Reducing unnecessary administrative burdens.
• Supporting independent physician practices.
• Improving physician participation in value-based care.
• Creating greater stability within the Medicare Physician Fee Schedule.

LUGPA looks forward to working with Congress to advance meaningful physician payment reform that protects patient access and strengthens physician-led specialty care