A Bipartisan Proposal for Lasting Medicare Physician Payment Reform

For years, physicians have faced an increasingly familiar cycle: Medicare proposes another payment reduction, medical organizations warn about the consequences for patient access, and Congress considers a temporary intervention shortly before the cut takes effect. A new bipartisan bill seeks to replace that uncertainty with a more sustainable system.

The Patients First Act of 2026 (H.R. 9693), introduced by Representatives John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA), would make several significant changes to Medicare physician payment. Most importantly, the legislation would establish predictable annual payment updates tied to the Medicare Economic Index, which measures changes in the cost of operating a medical practice. Unlike hospitals and other Medicare providers, physicians currently do not receive an adequate annual inflationary update. Over time, that disconnect has placed increasing pressure on independent practices and contributed to healthcare consolidation.

The bill would also modernize Medicare’s budget-neutrality requirements. Under current law, changes expected to increase physician spending by more than $20 million must be offset through reductions elsewhere in the physician fee schedule. That threshold was established decades ago and has never been updated, allowing the introduction or revaluation of services to produce disruptive, across-the-board payment reductions. H.R. 9693 would raise and index the threshold, require Medicare to correct inaccurate utilization estimates, and limit dramatic year-to-year changes in the conversion factor.

Other provisions would replace the burdensome Merit-based Incentive Payment System with a more clinically meaningful, physician-informed quality program; improve opportunities to participate in alternative payment models; and extend geographic payment protections that benefit physicians practicing in rural and lower-cost areas. Heart Rhythm Advocates supports the direction of H.R. 9693. Predictable payment updates and sensible budget-neutrality policies are essential to preserving patient access to physician-led care, including specialized heart rhythm services.

At the same time, expectations should be realistic. H.R. 9693 is a comprehensive proposal introduced late in the congressional session. With limited legislative time remaining, no Senate companion, and no identified agreement on how to finance its provisions, the bill is unlikely to pass as a standalone measure this year.

That does not make advocacy irrelevant – quite the contrary. Growing bipartisan support can position the bill’s strongest provisions for inclusion in a broader year-end Medicare or healthcare package. It can also establish a foundation for comprehensive physician-payment reform in the next Congress.

HRA members can help by asking their representatives to cosponsor H.R. 9693 and support the inclusion of permanent payment updates and budget-neutrality reforms in any Medicare legislation considered before the end of the year. Congress may not enact the entire bill immediately, but continued pressure is necessary to move beyond temporary patches and toward a Medicare payment system that offers physicians - and their patients - greater stability.