Medicare to test monthly primary care payments

Summary#

The Patients First Act of 2026 would amend title XVIII of the Social Security Act, which governs Medicare. It would change physician payment rules, create a temporary monthly-payment model for some primary care practices, and revise Medicare’s clinician performance-payment system. Its stated goal is to strengthen reimbursement and patient access; the bill does not guarantee those results. It was introduced in the Senate and is not law.

  • From 2027, it would change annual updates to Medicare’s physician payment rates and require reports on effects on patient access and practice consolidation.
  • From 2027 through 2031, the Health and Human Services Secretary would have to run a monthly-payment model for eligible primary care suppliers serving certain people with Medicare Part B.
  • It would change geographic payment adjustments in years when consumer prices rise by more than 2% over the prior 12 months, and require quarterly publication of geographic payment values.
  • From 2032, it would rename the existing MIPS payment system “POINTS” and add care-efficiency measures. A new task force would recommend measures; the Secretary would generally have to include recommended measures or explain exclusions.
  • It would change MIPS payment adjustments, rules for clinical data registries and claims-data access, and reporting for certain imaging services.
  • It would change physician fee-schedule rules, including the budget-neutrality threshold and limits on yearly payment-rate changes.

What it means for you#

  • Medicare Part B patients outside Medicare Advantage: You could designate an eligible supplier as your primary care provider for the model. If you do not, the Secretary may attribute you to a supplier based on past claims. The monthly payment replaces fee-schedule payment for listed primary care services for attributed patients; the bill does not say that all care would be free of patient cost sharing.
  • Primary care physicians and practitioners: To take part, a supplier would have to meet specialty, prior-year service, payment-share and election rules. At least 60% of the supplier’s prior-year Medicare payments must have been for designated primary care services. The model excludes certain practices with non-practitioner ownership or control, but not a practice of 15 or fewer designated health care practitioners.
  • Other clinicians and practices: The bill would make new MIPS and data-reporting rules. For performance periods beginning in 2032, failure to report an applicable quality measure through certified electronic health records or a clinical data registry would mean the lowest possible score for that measure. The bill also gives the highest possible score for certain new, substantively changed or unbenchmarked measures if a clinician chooses to report them.
  • Ordering clinicians and imaging providers: The bill would require reporting about use of decision-support tools for some imaging orders, with exemptions including clinical trials, certain small or rural practices, mammograms, lung cancer screening and emergency care. It does not itself impose prior authorization for low-compliance clinicians; it directs a later study to consider possible approaches.
  • Patients and the public generally: POINTS would be a renamed and revised payment system, not a new front-line patient service or independent agency.

Money#

The bill specifies new payment rules and funding sources, but no cost estimate is available in the supplied material.

  • The primary care model would be paid from the Federal Supplementary Medical Insurance Trust Fund. Its monthly amounts would be based on estimated national payments, adjusted geographically and for risk.
  • Medicare would charge data registries a reasonable fee equal to the cost of providing claims data; collected fees would go to the Centers for Medicare & Medicaid Services Program Management Account.
  • The bill raises the physician-fee-schedule budget-neutrality threshold to $57.64 million in 2028, from $20 million before 2028, with later indexing rules. It also requires certain corrections when estimated use differs from actual use.
  • The bill requires staff work, reports, a task force and updates to cost inputs, but gives no staffing or administrative-cost estimate.

What is unclear#

  • The current versions of the Social Security Act provisions being amended were not supplied, so the exact change from current law could not be independently checked.
  • The Secretary would set important model details, including geographic and risk adjustments, attribution rules and the process for electing to participate.
  • The bill does not fully explain how the primary care model would interact with other Medicare payment arrangements, or what review or appeal process applies to attribution or eligibility decisions.
  • It does not define several key terms in the text, including “substantively changed” measure; it leaves the Secretary to define that term and several other operational details.
  • No fiscal estimate is provided for the payment changes, model, task force, reporting duties or data systems.

Case for#

  • A possible argument for the bill is that predictable monthly payments could support primary care work that is not captured well by payment for individual services.
  • Updating geographic adjustments and practice-cost inputs could make Medicare payment calculations more responsive to local conditions and changing costs.
  • A task force with clinician and specialty representation could help make performance measures more clinically relevant. The bill also requires the Secretary to explain decisions to reject its recommendations.
  • Better access to claims data and regular feedback could support quality assessment and improvement, while the bill protects registries’ ownership of their measures.

Case against#

  • The bill would direct new federal payments without a supplied estimate of their cost or their effect on the Medicare trust fund.
  • The primary care model’s eligibility and ownership rules could exclude some practices, while attribution based on claims could assign a patient to a supplier without that patient’s designation.
  • The bill gives the Secretary substantial discretion over payment adjustments, attribution, exemptions and data rules; important details would depend on later decisions.
  • New measure, reporting and data requirements could add work for clinicians and registries. The bill does not estimate that burden or specify a full process for challenging decisions.