Overhauling Medicare: The Patients First Act Initiative
A coalition of physician lawmakers has introduced new legislation that aims to overhaul the Medicare physician payment system, enhancing the stability of independent medical practices and improving healthcare access. On July 15, 2026, Representatives John Joyce, MD, Greg Murphy, MD, and Kim Schrier, MD, presented the Patients First Act to revise the Medicare Access and CHIP Reauthorization Act (MACRA). This initiative addresses issues related to physician revenue, healthcare consolidation, and administrative inefficiencies.
The legislation seeks to provide financial predictability for medical practices, promote competition, and ensure continued access to healthcare, particularly in rural and underserved areas. Established in 2015, MACRA replaced the sustainable growth rate formula with the Merit-based Incentive Payment System (MIPS). However, the current framework has been criticized for inadequately addressing operational costs and healthcare management shifts.
Focus on Independent Practices
A primary aim of the Patients First Act is to support independent physician practices facing low reimbursement rates and rising expenses. The release indicates that hospital or corporate ownership now encompasses nearly 70% of U.S. medical practices, impacting competition and potentially increasing patient costs. Representative Joyce stressed the critical need for a reformed payment system that supports physician sustainability and advances patient care.
Rep. Murphy, a practicing urologist, underscored the difficulties under the existing payment system, contributing to consolidation and administrative burdens, particularly in rural healthcare environments. He posits that the Patients First Act aims to ease these challenges, allowing physicians to prioritize patient care over bureaucratic obstacles.
Key Legislative Changes
The proposed legislation includes linking physician reimbursement to an inflation index, offering more stable financial prospects for Medicare-engaged practices. This could provide independent practices the means to maintain operations and invest in growth while ensuring patient services continue. Additionally, the Act outlines a hybrid payment pilot for primary care, combining per-member and service-based payments to better support the extensive services offered by primary care doctors.
Further, the POINTS program within the Centers for Medicare & Medicaid Services seeks to reduce administrative burdens with practical quality measures. Adjustments to advanced alternative payment models are also suggested, including freezing participation thresholds temporarily and introducing commentary periods for new models by the Center for Medicare & Medicaid Innovation.
The Patients First Act represents a bipartisan initiative aimed at reforming the Medicare payment system. The goal is to maintain physician accessibility, foster competition, and ensure care delivery across various communities. The proposal is now set for evaluation and potential endorsement by Congress, marking a crucial step in updating the MACRA framework to reflect current healthcare and economic landscapes.