Patients First Act of 2026

Key Points

• Starting in 2027, Medicare will tie annual doctor pay updates to the Medicare Economic Index (a measure of practice costs), minus 1 percentage point, with a floor and ceiling so updates cannot swing too far. This is meant to help doctor pay keep up with the rising cost of running a practice.
• A hybrid payment model runs from 2027 through 2031 for primary care. Doctors get a flat monthly fee for each patient instead of billing for each visit or message, and patients pay no cost sharing on those payments.
• In 2032 the current quality program MIPS is renamed POINTS and adds a new care efficiency category rewarding things like fewer avoidable hospital stays and fewer chronic disease complications. A new Quality Reform Task Force made mostly of clinicians will recommend which measures to use.
• The bill adds a pay boost to the work geographic index in high inflation years (when consumer prices rise more than 2 percent) through 2032, and requires the government to update the direct costs of staff wages, supplies, and equipment at least every five years.
• The bill changes the budget neutrality rules that often trigger automatic doctor pay cuts. It raises the threshold from $20 million to about $57.6 million in 2028 (indexed afterward) and limits year-to-year conversion factor swings to 2.5 percent.
• Practices majority owned or controlled by non-physician entities (labeled excluded practices) face a 50 percent cut to positive MIPS adjustments starting 2032 and are locked out of the hybrid model, favoring physician-owned and smaller practices.