Lawmakers from both parties are showing new interest in permanently changing how Medicare pays doctors rather than passing another one-year fix, Axios reported on Wednesday. The shift follows a September 15 House hearing where members aired frustration with the yearly cycle of scheduled cuts and last-minute patches.
An overhaul is possible but far from certain. Congress has little time left before the midterm elections, and a permanent fix could cost billions of dollars that lawmakers would need to offset. Axios reported that Congress will most likely pass another short-term patch at year's end to cancel a proposed payment cut scheduled for January 1.
For Medicare patients, the debate is about access. Physician groups say shrinking payments push independent practices to sell to hospital systems or limit how many Medicare patients they see. A separate proposal to cut pay for same-day visits and procedures could also mean an extra trip to the doctor for some older adults.
A Bipartisan Bill Built Around Inflation Updates
The plan drawing the most attention is H.R. 9693, the Patients First Act of 2026. It was introduced July 15 by three physician lawmakers: Reps. John Joyce of Pennsylvania and Greg Murphy of North Carolina, who co-lead the Republican Doctors Caucus, and Rep. Kim Schrier of Washington, who leads the Democratic Doctors Caucus, Medical Economics reported.
The bill would replace the yearly update formula set by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) with automatic annual updates tied to inflation. According to Axios, it would also launch a pilot giving primary care practices a monthly payment on top of regular fees. "We often talk about expanding access to high-quality care, but without meaningful Medicare reimbursement reform, that mission becomes nearly impossible to achieve," Joyce said in a statement when the bill was introduced.
Backers see the overhaul as a way to keep independent practices open. The sponsors say nearly 70% of U.S. medical practices are now owned by hospitals or other corporations. The American Medical Association supports the bill, which had 30 cosponsors within weeks of its introduction.
The catch is cost. Tying payments to inflation could raise Medicare spending by billions, and lawmakers would need to find ways to pay for it regardless of which party controls Congress next year. An analyst cited by Axios said the bipartisan enthusiasm showed growing support for a permanent redesign, but cautioned that the midterms, thin margins, and disputes over how to pay for health bills limit what Congress can pass beyond typical year-end extensions.
The Proposed 2027 Cut and the Same-Day Visit Change
MedicalDaily previously reported on the proposed 2027 physician pay cut, which CMS released July 14. Under the proposed rule, the payment conversion factor for most physicians would fall 1.68%, to $32.84, largely because a one-year 2.5% increase Congress provided for 2026 expires. Clinicians who qualify through advanced alternative payment models would see a 1.19% drop, to $33.17.
Since then, attention has shifted to a less visible provision. CMS proposes paying the most expensive service in full and paying 50% for other procedures or office visits provided on the same day. The change would apply when the same physician or practice provides both services, which is often flagged on claims with a billing code known as modifier 25.
Physician groups have urged CMS to drop the change. They warn that payment for some procedures could fall below practices' costs and push doctors to schedule procedures on a separate day. Dermatology, eye care, and ear, nose, and throat practices often pair office visits with same-day procedures and could be among the most affected.
What Medicare Patients and Families Can Do Now
The heaviest burden could fall on older adults who rely on independent, office-based practices, including in rural areas where specialists are already scarce. A patient who today has a suspicious skin spot examined and removed in one visit might be asked to come back under the proposal. That could mean more travel, another day off for a family caregiver, and possibly a second copay.
Nothing changes for patients yet. The rule is not final, and CMS could still drop some provisions, as it did with a similar same-day proposal in 2019. The public comment period closed September 14, and CMS usually publishes the final physician payment rule in early November, ahead of the January 1 effective date.
Families can take practical steps now. Medicare open enrollment runs from October 15 to December 7, a good time to confirm that regular doctors remain in a plan's network. Patients expecting a minor procedure early next year can ask whether it can be done during the same visit and what they would owe if a second appointment becomes necessary.
The central question is whether Congress takes up a long-term overhaul in 2027 or repeats the patch cycle. MedicalDaily will report what CMS finalizes in November and whether lawmakers approve another short-term fix before the cut takes effect.
Key Questions Answered
Is Congress going to overhaul Medicare doctor pay? It is possible but not certain. Axios reported growing bipartisan interest, but another short-term patch is more likely before the proposed cut takes effect.
What cut is scheduled for 2027? CMS proposed a 1.68% cut to the conversion factor for most physicians and a 1.19% cut for qualifying participants in advanced alternative payment models, effective January 1 if finalized.
What is the Patients First Act? H.R. 9693 would replace Medicare's current physician payment update formula with automatic annual updates tied to inflation. Axios reported it would also create a primary care payment pilot.
What is the same-day visit proposal? CMS would pay the most expensive service in full and pay 50% for other visits or procedures the same physician or practice provides that day.
Could this affect my care? Some physician groups warn that practices may schedule procedures on a separate day, which could mean extra trips. No change takes effect unless CMS finalizes the rule.
When will we know more? CMS usually issues its final physician payment rule in early November, and Congress would need to act before January 1 to cancel the cut.
Published by Medicaldaily.com
