Article Summary
The Patients First Act is bipartisan legislation introduced in Congress that would reform Medicare physician payment policy by modernizing imaging guidelines through the ROOT Act, replacing the current Medicare conversion factor update with a more stable approach, and creating new quality metrics to improve patient outcomes.
- The Patients First Act was introduced July 14 by physician members of Congress from both parties, including chairs of the Republican and Democratic Doctors Caucuses.
- The bill includes the ROOT Act, which would modernize Medicare's imaging appropriateness use criteria program by allowing physicians to use clinical decision support tools while maintaining clinical judgment.
- The legislation would replace the current Medicare Physician Fee Schedule conversion factor with one tied to the Medicare Economic Index minus 1 percentage point, while supporting faster-growing payments for Advanced Alternative Payment Model participants.
- The bill would establish the Patient Outcome Improvement National Tabulation System (POINTS) to eventually replace the Merit-based Incentive Payment System, reducing year-to-year payment fluctuations.
- Major medical societies including the American College of Radiology and American Society for Radiation Oncology support the legislation as a practical path to improve patient access and reduce unnecessary imaging costs.
Radiology associations have applauded the introduction in Congress July 14 of the Patients First Act, bipartisan legislation aimed at reforming Medicare physician payment policy.
The bill was introduced by Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA), the respective chairs of the Republican and Democratic Doctors Caucuses, and includes provisions affecting imaging appropriate use criteria (AUC), the Medicare conversion factor, and the Quality Payment Program (QPP).
Significantly, the bill incorporates the Radiology Outpatient Ordering Transmission (ROOT) Act, which would modernize implementation of Medicare's imaging AUC program, according to the American College of Radiology (ACR). Providers would use AUC-based clinical decision support tools to consult multi-specialty-developed, evidence-based guidelines at the point of care. Physicians would maintain their clinical judgment and only need to document that they consulted the guidelines, the ACR said.
“Inclusion of the ROOT Act offers a practical path forward that can help improve access and ensure patients receive the most appropriate imaging exams while reducing unnecessary, low-value scans and associated costs,” said ACR CEO Dana H. Smetherman, MD.
The legislation would also replace the current Medicare Physician Fee Schedule (MPFS) conversion factor update with one tied to the Medicare Economic Index (MEI) minus 1 percentage point, while maintaining a separate, faster-growing conversion factor for qualifying Advanced Alternative Payment Model (APM) participants.
It would also establish the Patient Outcome Improvement National Tabulation System (POINTS) to eventually replace the Merit-based Incentive Payment System (MIPS), create a physician-led task force at the Centers for Medicare and Medicaid Services (CMS) to develop new quality metrics, and adjust Medicare budget-neutrality policy to reduce year-to-year payment fluctuations.
The ACR said it will continue working with Congress to advance the legislation.
The American Society for Radiation Oncology (ASTRO) also welcomed the bill's introduction and noted that alongside the separately introduced Radiation Oncology Case Rate (ROCR) Act, the legislation would help address access challenges in radiation oncology.
“ROCR would complement the Patients First Act by creating a more stable and predictable payment framework that supports community-based cancer care while generating Medicare savings that could help offset the cost of broader physician payment reforms,” said ASTRO CEO Vivek Kavadi, MD, in a statement.
The ROCR Act has 42 bipartisan cosponsors across the House and Senate, according to the society, and more than 130 patient, provider, and healthcare organizations signed a May letter supporting its inclusion in broader payment reform efforts. ASTRO said it looks forward to working with Congress to advance both bills as part of a broader strategy to stabilize Medicare payment and preserve patient access to cancer care.
