Diverse collection of patient advocacy groups endorse Medicare physician pay reform legislation
For decades, the AMA has rung the alarm on Capitol Hill that declining Medicare payment rates will lead to decreased patient access to care. On Oct. 6, a diverse coalition of 24 patient advocacy organizations representing rare disease, oncology, autoimmune and inflammatory conditions, neurological disease, and chronic pain sent a letter (PDF) to House and Senate leadership endorsing H.R. 9693, the Patients First Act. The letter was spearheaded by Patients Rising, an advocacy group focused on ensuring that the patient perspective is present wherever healthcare policy discussions occur.
The sign-on letter states that, “As the collective voices of America’s patient community, we are deeply concerned about the increasing unstable Medicare system that is stifling patient access to care and are writing to express our strong support for the Patients First Act (H.R. 9693).” In addition, patient advocacy groups highlight the damaging impact of both sustained payment cuts and the inability of Medicare reimbursement to cover the cost of providing patient care. More specifically:
Over the last 25 years, Medicare reimbursement for physicians has been eroded away and is now a full-third (33%) below 2001 payment levels. These cuts have been driven in part by budget neutrality rules that have not been updated in over thirty years. We’ve heard from many physicians that Medicare policies meant to improve value-based care – a worthy goal- have instead imposed significant administrative burdens and additional costs without meaningfully improving outcome. All this has coincided with a steep drop in the number of independent and private practices in the community, as well as a growing shortage of physicians nationwide.
Introduced by Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC) and Kim Schrier, MD (D-WA), the co-chairs of the GOP & Democratic Doctors Caucuses, respectively, this bipartisan bill addresses numerous structural flaws in the Medicare physician payment system. The bill would tie annual Medicare physician payment updates to the Medicare Economic Index (MEI) minus one percentage point, provide larger updates for clinicians participating in advanced alternative payment models, and reform budget neutrality rules in an identical manner as H.R. 8163, the Provider Reimbursement Stability Act, as passed by the House Ways and Means Committee in May 2026. The legislation also overhauls MACRA’s Merit-based Incentive Payment System (MIPS) and rebrands it as the Patient Outcome Improvement National Tabulation System (POINTS) program. Under POINTS, the bill replaces and revalues the four MIPS quality assurance programs with three performance categories (i.e., “Quality,” “Resource Use,” and “Care Efficiency”), thus eliminating Promoting Interoperability. In addition, it requires CMS to establish a Quality Care Reform Task Force, comprised of a majority of medical clinicians, to develop and implement the new metrics for the three POINTS performance categories over a five-year period. During the five-year review period, the existing MIPS plus or minus 9% payment structure is lowered to plus or minus 2% before being permanently raised to plus or minus 5%.
Currently cosponsored by 65 bipartisan members of Congress, AMA will continue to push for H.R. 9693 to be enacted before the end of the 119th Congress.
Bipartisan legislation would improve process for resolving Medicare coverage questions
On Oct. 9, the AMA shared a letter (PDF) of support for bipartisan legislation, S. 5475, the Timely Access to Covered Decisions Act introduced by Senators Ben Ray Luján (D-NM) and Tom Cotton (R-AR). This important legislation, the companion to H.R. 8500, establishes enforceable timelines for Medicare administrative contractor (MAC) review of local coverage determination (LCD) requests and reconsideration requests, modernizes the LCD development process to require public meetings and expert clinical input, and provides for agency-level review of final reconsideration decisions. The LCD process has always been slow, inconsistent across contractors, and opaque. This bill will go a long way toward providing transparency, modernizing the process and addressing these delays that have real consequences for patients and the physicians who care for them. The AMA along with members of the Federation of Medicine, like the College of American Pathologists, will continue to work the bill sponsors to see the important legislation move this session.
Is your cybersecurity risk assessment up to date? A free resource can help
October is National Cybersecurity Awareness Month, so take the opportunity to leverage an updated risk assessment tool from the Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR).
ONC and OCR have released the free Security Risk Assessment (SRA) Tool version 3.7 to help small- and medium-sized physician practices identify and assess potential risks and vulnerabilities to electronic protected health information as part of the risk analysis required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. ONC’s website includes the new tool, a user guide, an Excel workbook and other training materials.
The tool can help physician practices organize their risk analysis and identify areas that need attention. Use it as part of an ongoing risk management process in which physician practices work with their electronic health record (EHR), information technology and cybersecurity vendors to determine who is responsible for evaluating and correcting risks in technology systems, connected devices and other technology used by the practice.
Version 3.7 adds and updates questions addressing the scope of a practice’s assessment, remote access and telework, technology asset inventories, system activity logging, and circumstances that may require a security risk assessment to be reviewed or updated. It also improves reports and references software updates and potential vulnerabilities.
Are you interested in learning more about safeguarding your patient health records and other sensitive information? Visit the AMA’s Physician Cybersecurity resource center for more information and tips.
