Patients First Act of 2026
Sponsored By: Representative Joyce, John [R-PA-13]
Introduced
Summary
Medicare physician payment reform would redraw how doctors get paid and how performance is measured in Medicare, with new conversion‑factor rules and a test of monthly primary care payments.
Show full summary
- Families and Medicare patients would see a new hybrid primary care payment option through 2031 that pays a monthly amount per attributed beneficiary with no beneficiary cost sharing and lets most Part B enrollees pick or be assigned a primary care supplier.
- Physicians and practices would face conversion‑factor updates tied to the Medicare Economic Index, with non‑APM updates set at MEI minus 1.0 percentage point and qualifying APM updates boosted by 0.5 percentage points, plus limits on year‑to‑year conversion factor swings and new five‑year practice expense update rules.
- Quality programs and registries would shift toward a POINTS system starting 2032, create a practitioner‑majority Task Force to set measures, expand registry access to claims data, protect registry intellectual property, and tighten imaging decision support rules starting 2027.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 2 benefits, 0 costs, 4 mixed.
New Medicare physician payment rules
If enacted, this package would change how Medicare updates physician payments starting in 2027. Non‑APM updates would be set as the Medicare Economic Index estimate minus 1.0 percentage point, with the non‑qualifying update floored at 25% and capped at 75% of the MEI estimate, and qualifying APM updates would be 0.5 percentage point higher. The Secretary could not let the conversion factor change more than 2.5% from one year to the next starting in 2027. Beginning with adjustments tied to 2029 years, CMS would reconcile large errors between estimated and actual utilization (trigger: differences over 0.1% of estimated Part B spending) and adjust the conversion factor in the correction year. The Secretary would also update practice‑expense cost inputs at least once every five years.
Monthly primary care payments for Medicare
If enacted, the bill would create a nationwide hybrid primary care model for 2027 through 2031. Qualifying suppliers would be paid a monthly amount (one‑twelfth of the national average payment for designated primary care services, estimated as if no Part B cost sharing applied), adjusted for geography and risk. Attributed Part B beneficiaries not in Medicare Advantage would not owe cost sharing for those covered primary care services while the supplier receives the monthly payment. The model would be paid from the Medicare Part B (SMI) trust fund and has specific eligibility and small‑practice exemptions.
Clinical registries get Medicare data
If enacted, the Secretary would let qualified clinical data registries request Medicare claims data by January 1, 2027. The Secretary could also allow Medicaid and CHIP data. Registries applying on or after that date must meet new standards and would get 3‑year designations (extendable). Registries would pay reasonable fees equal to the cost of providing data and would keep ownership of any measures they develop.
MIPS replaced by POINTS system
If enacted, the Merit‑based Incentive Payment System (MIPS) would be replaced by a new POINTS system starting January 1, 2032, with a required transition. The bill would create a Quality Reform Task Force to recommend quality, resource‑use, and new care‑efficiency measures for POINTS and require the Secretary to respond to recommendations within 120 days. The bill would cap annual MIPS adjustment percentages at lower levels for 2027–2034, require quarterly feedback to clinicians starting in 2032, and treat reporting of new or changed measures as the top score for reporting clinicians.
New rules for imaging decision support
If enacted, for imaging on or after January 1, 2027 qualified clinical decision support systems would have new reporting duties and must provide specified information to the Secretary. The ordering clinician's national provider identifier would be required on applicable imaging claims. The bill expands exceptions (for small practices of 15 or fewer ordering professionals, certain screening services, HPSA rural practices, and clinical trials). The Secretary must annually identify 'low compliant' ordering professionals and report to Congress by January 1, 2031 and every five years after.
Tighter review and reports for models
If enacted, the bill would require more notice‑and‑comment rulemaking for certain federal health models and limit early termination of expanded models to actions that follow notice‑and‑comment. Reports starting in 2027 would have to describe any savings generated by each tested model. These steps increase transparency and public input but also add procedural steps before the Secretary can change or end models.
Sponsors & CoSponsors
Sponsor
Joyce, John [R-PA-13]
PA • R
Cosponsors
Rep. Schrier, Kim [D-WA-8]
WA • D
Sponsored 7/15/2026
Rep. Murphy, Gregory F. [R-NC-3]
NC • R
Sponsored 7/15/2026
Rep. Bera, Ami [D-CA-6]
CA • D
Sponsored 7/15/2026
Rep. Dunn, Neal P. [R-FL-2]
FL • R
Sponsored 7/15/2026
Rep. Conaway, Herbert C. [D-NJ-3]
NJ • D
Sponsored 7/15/2026
Rep. Harris, Andy [R-MD-1]
MD • R
Sponsored 7/15/2026
Rep. Morrison, Kelly [D-MN-3]
MN • D
Sponsored 7/15/2026
Rep. Miller-Meeks, Mariannette [R-IA-1]
IA • R
Sponsored 7/15/2026
Rep. Dexter, Maxine [D-OR-3]
OR • D
Sponsored 7/15/2026
Rep. Harshbarger, Diana [R-TN-1]
TN • R
Sponsored 7/15/2026
Rep. Veasey, Marc A. [D-TX-33]
TX • D
Sponsored 7/15/2026
Rep. Carter, Earl L. "Buddy" [R-GA-1]
GA • R
Sponsored 7/15/2026
Rep. Sewell, Terri A. [D-AL-7]
AL • D
Sponsored 7/15/2026
Rep. Onder, Robert F. [R-MO-3]
MO • R
Sponsored 7/15/2026
Rep. DelBene, Suzan K. [D-WA-1]
WA • D
Sponsored 7/15/2026
Rep. Babin, Brian [R-TX-36]
TX • R
Sponsored 7/15/2026
Rep. Panetta, Jimmy [D-CA-19]
CA • D
Sponsored 7/15/2026
Rep. McCormick, Richard [R-GA-7]
GA • R
Sponsored 7/15/2026
Rep. Suozzi, Thomas R. [D-NY-3]
NY • D
Sponsored 7/15/2026
Rep. Biggs, Sheri [R-SC-3]
SC • R
Sponsored 7/15/2026
Rep. Fletcher, Lizzie [D-TX-7]
TX • D
Sponsored 7/15/2026
Rep. Bilirakis, Gus M. [R-FL-12]
FL • R
Sponsored 7/15/2026
Rep. Trahan, Lori [D-MA-3]
MA • D
Sponsored 7/15/2026
Rep. Miller, Carol D. [R-WV-1]
WV • R
Sponsored 7/15/2026
Rep. LaHood, Darin [R-IL-16]
IL • R
Sponsored 7/15/2026
Rep. Kelly, Robin L. [D-IL-2]
IL • D
Sponsored 7/15/2026
Rep. Van Drew, Jefferson [R-NJ-2]
NJ • R
Sponsored 7/15/2026
Rep. Barragán, Nanette Diaz [D-CA-44]
CA • D
Sponsored 7/16/2026
Rep. Van Duyne, Beth [R-TX-24]
TX • R
Sponsored 7/23/2026
Rep. Landsman, Greg [D-OH-1]
OH • D
Sponsored 7/27/2026
Rep. Peters, Scott H. [D-CA-50]
CA • D
Sponsored 8/6/2026
Rep. Houchin, Erin [R-IN-9]
IN • R
Sponsored 8/6/2026
Rep. Gallagher, James [R-CA-1]
CA • R
Sponsored 8/6/2026
Rep. Meuser, Daniel [R-PA-9]
PA • R
Sponsored 8/10/2026
Rep. Hinson, Ashley [R-IA-2]
IA • R
Sponsored 8/10/2026
Rep. Bynum, Janelle S. [D-OR-5]
OR • D
Sponsored 8/20/2026
Rep. Thompson, Bennie G. [D-MS-2]
MS • D
Sponsored 8/20/2026
Rep. Fitzpatrick, Brian K. [R-PA-1]
PA • R
Sponsored 8/20/2026
Rep. Correa, J. Luis [D-CA-46]
CA • D
Sponsored 8/20/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov