Bill > S5672

This bill, titled the Patients First Act of 2026, proposes comprehensive reforms to the Medicare physician payment system under Title XVIII of the Social Security Act to improve provider reimbursement, patient access, and value-based care. Specifically, it modifies the annual updates to the Medicare physician conversion factor—which is the monetary multiplier used to calculate how much doctors are paid for services—by tying them to the Medicare Economic Index (MEI), an official measure of changes in the operating costs of physician practices and general inflation. The legislation introduces a temporary hybrid payment model for primary care services running from 2027 through 2031, providing qualifying independent primary care practitioners with predictable monthly payments per assigned patient instead of traditional fee-for-service billing. Additionally, the bill reforms the Merit-based Incentive Payment System (MIPS)—a program that adjusts Medicare clinician payments based on quality and performance—by renaming it the Patient Outcome Improvement National Tabulation System (POINTS) by 2032, establishing a dedicated Quality Reform Task Force to vet and recommend clinical performance measures, and adding a new "care efficiency" performance category. To support transparency and reduce administrative burdens, the legislation expands clinician access to Medicare claims data for research and quality improvement, streamlines appropriate use criteria data collection for medical imaging services, and freezes certain participation thresholds for Alternative Payment Models (APMs). Finally, the bill addresses long-standing provider concerns regarding Medicare's budget neutrality requirements—the statutory rule that any increase in payment for a particular service must be offset by a reduction elsewhere—by updating adjustment thresholds, limiting year-to-year conversion factor variances to 2.5 percent, and mandating more frequent updates to the direct costs and practice expense relative value units used in calculating physician remuneration.