Reps. Dr. John Joyce (D-Pa.), Dr. Greg Murphy (R-N.C.) and Dr. Kim Schrier (D-Wash.) have introduced the Patients First Act. The legislation is aimed at strengthening healthcare access, including among seriously ill seniors.
The legislation reforms the Medicare physician fee schedule and establishes a primary care hybrid payment pilot program. The legislation was introduced to reduce administrative and financial burden for providers and improve patient access, particularly among rural, underserved communities.
Decades of healthcare consolidation have resulted in increased costs for physicians serving seniors in rural and under-resourced regions, Joyce said in a press release. The Patients First Act is designed to improve access by strengthening payment incentives.
“The House of Medicine is at a crossroads,” Joyce said in a press release. “The Patients First Act is necessary to keep patients healthy, preserve competition and deliver affordability. We often talk about expanding access to high-quality care, but without meaningful Medicare reimbursement reform, that mission becomes nearly impossible to achieve.”
The new legislation is designed to update the comprehensive Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA). Unveiled in 2015, MACRA introduced a new methodology that tied physician payment to inflation and established primary care alternative payment models.
Included in the Patient First Act is a new payment and quality metric system under development, : Patient Outcome Improvement National Tabulation System (POINTS). Under the POINTS system, providers’ quality metrics are evaluated based on reductions in complications of chronic diseases, avoidable hospitalizations and medication burden.
The legislation also introduced metrics that evaluate referral patterns to the lowest cost-clinically appropriate care setting.
A mounting volume of research has linked palliative care utilization to reduced pain and symptom burden among seriously ill seniors. Research has also found that these services can reduce overall healthcare costs and hospitalizations, particularly among patients with chronic, complex and serious illnesses such as cancer.
Seriously ill seniors in rural areas often lack access to primary and palliative care. Demand for palliative care has outpaced the growth of these programs for several years running. Recent research has found that more than 90% of board certified palliative physicians and nurse practitioners nationwide were located in metropolitan and urban areas in 2022.
The Patient First Act could help improve sustainability for primary and other healthcare providers during a time of significant demand, Murphy said in a press release.
The nation’s current Medicare payment system is “unsustainable,” and has fueled healthcare industry consolidation and increased administrative burden, he stated. Reimbursement challenges have made it harder for clinicians, particularly providers caring for underserved rural communities.
“As a practicing urologist for more than 30 years, I’ve seen firsthand the challenges physicians face in keeping their doors open while providing the highest quality care for their patients,” Murphy said in a press release. “The bipartisan Patients First Act delivers long-overdue reforms that strengthen independent practices, invest in primary care, and ensure physicians can spend more time caring for patients instead of navigating bureaucracy. When physicians succeed, patients receive better care, and that’s exactly what this legislation is designed to achieve.”
