The Patients First Act Would Tie Medicare Physician Pay to Inflation Minus One Point and Replace MIPS
H.R. 9693, now with 65 bipartisan cosponsors, would index annual updates to the Medicare Economic Index minus 1 percentage point and shrink the MIPS adjustment to plus or minus 2 percent for five years. It remains in committee.
A bipartisan House bill would replace the annual fight over Medicare physician payment with a formula, and rebuild the Merit-based Incentive Payment System on the way. The Patients First Act, H.R. 9693, now has 65 cosponsors, according to the American Medical Association's Oct. 16 national advocacy update.
Reps. John Joyce, MD (R-Pa.), Greg Murphy, MD (R-N.C.) and Kim Schrier, MD (D-Wash.) introduced the bill on July 15, and it was referred to the Energy and Commerce and Ways and Means committees, according to the legislative record. The Energy and Commerce health subcommittee took it up at a hearing in September. The AMA's stated goal is enactment before the end of the 119th Congress. Passage is not assured, and nothing in the bill changes 2027 rates.
What the bill would do on payment
Annual Medicare physician payment updates would be tied to the Medicare Economic Index (MEI) minus one percentage point. Clinicians in advanced alternative payment models would receive larger updates. The bill would also reform budget neutrality rules in the same way as H.R. 8163, the Provider Reimbursement Stability Act, which the House Ways and Means Committee passed in May 2026, per the AMA.
Supporters point to the gap between payment and costs. On Oct. 6, a coalition of 24 patient advocacy organizations led by Patients Rising sent House and Senate leaders a letter endorsing the bill. As summarized by the AMA, the letter says Medicare physician pay is 33 percent below 2001 levels and that budget neutrality rules have not been updated in more than 30 years.
What it would do to MIPS
The bill would replace MIPS with the Patient Outcome Improvement National Tabulation System, or POINTS. The four current performance categories would become three: Quality, Resource Use and Care Efficiency. Promoting Interoperability would be eliminated. A Quality Care Reform Task Force, with a majority of medical clinicians, would develop the POINTS metrics over five years.
During that five-year period the payment adjustment would shrink from plus or minus 9 percent to plus or minus 2 percent, then be set permanently at plus or minus 5 percent, according to the AMA's description. The North Carolina Medical Society notes that the bill would also create a five-year pilot pairing fee-for-service payment with monthly care management payments for primary care practices.
An inflation-linked update with a one-point haircut would stop the annual cliff, not close the gap. Practices should plan on the current fee schedule until Congress acts.
What to watch
A bill with this many cosponsors still needs committee markups, a Congressional Budget Office score, a Senate counterpart and a legislative vehicle. Practices cannot bank any of it. What they can do is check how their current MIPS score and adjustment work out, and keep the assumptions in their 2027 budget tied to the proposed 2027 fee schedule. Watch for a markup in either committee, a CBO estimate and any Senate companion bill.
Reported, fact-checked and edited by The Script Pad's editorial staff.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
