- Recently introduced Patients First Act—supported by AMA—provides crucial Medicare payment reform
- AMA releases its in-depth summary and analysis of 2027 Medicare physician payment schedule proposed rule
- AMA supports House bill focused on physician oversight of AI prior authorization decisions
- Senate Health Committee passes Rural Obstetrics Readiness Act
- Proposed rule would create new category of limited excepted benefits for certain fertility services
- More articles in this issue
Recently introduced Patients First Act—supported by AMA—provides crucial Medicare payment reform
On July 15, the chairs of the GOP and Democratic Doctors Caucuses—Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC) and Kim Schrier, MD (D-WA)—along with 23 original cosponsors, introduced the Patients First Act (H.R. 9693), a comprehensive, bipartisan proposal to reform the Medicare physician payment system.
The legislation was developed over the past year through extensive consultation with the AMA and other physician organizations, and it aligns squarely with the Characteristics of a Rational Medicare Physician Payment System (PDF), the reform framework endorsed by more than 120 state medical associations and national medical specialty societies. The bill addresses all four of the core reforms organized medicine has sought for more than a decade: annual inflation-based payment updates, modernized budget neutrality policies, simplified and clinically relevant quality measurement, and expanded opportunities to participate in alternative payment models (APM).
Most importantly, the bill establishes a permanent annual payment update tied to the Medicare Economic Index (MEI), built into the baseline so that Medicare payment tracks growth in the actual costs of running a practice. The legislation also incorporates the budget neutrality reforms of the Provider Reimbursement Stability Act (H.R. 8163), raising the outdated $20 million threshold, correcting CMS utilization misestimates, and capping year-to-year conversion factor swings. In addition, the bill replaces MIPS with the new Patient Outcome Improvement National Tabulation System (POINTS)—putting physicians and specialty societies, rather than the government, at the center of quality measurement through a clinician-majority task force while sharply reducing maximum penalties—and it freezes the APM Qualifying Participant threshold at 50%, extends and increases the work GPCI floor benefiting rural areas and 34 entire states, and establishes a fully funded, five-year hybrid payment demonstration for independent primary care practices that is exempt from budget neutrality.
On July 22, the AMA sent the sponsors a letter of support (PDF) signed by AMA CEO John Whyte, MD, MPH, commending their bipartisan leadership in crafting this significant legislation and urging colleagues on both sides of the aisle to join as cosponsors. The AMA is now working closely with the bill sponsors, state medical associations, and national medical specialty societies to build cosponsors and advance H.R. 9693 through the legislative process.
Physicians can help build momentum today by using the AMA's grassroots action alert to urge their representative to cosponsor the Patients First Act.
AMA releases its in-depth summary and analysis of 2027 Medicare physician payment schedule proposed rule
On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Revisions to Payment Policies under the Medicare Physician Payment Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies proposed rule (PDF) and fact sheet. The proposed rule includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). If finalized, these policies will take effect on Jan. 1, 2027, unless otherwise noted.
To help physicians understand the impact of the final rule, the AMA developed a detailed summary and analysis (PDF) outlining the major provisions of the proposed rule and how they impact physicians, including:
A proposed conversion factor decrease of -1.19% for Alternative Payment Model (APM) participants and -1.68% for other physicians, reflecting expiration of a temporary 2.5% update for CY 2026 included in H.R. 1, a 0.53% budget neutrality adjustment to balance proposed coding and payment policy changes, and the base 0.25% physician update and 0.75% APM participant updates under MACRA. The AMA will continue to advocate to Congress for a permanent Medicare payment update tied to inflation.
Proposed changes to the practice expense (PE) methodology, including allocating indirect PE based on physician work RVUs and clinical labor for all services except 10- and 90-day globals, removing indirect practice cost indices, resulting in redistribution across specialties, and capping payment changes on services that are not new, revised or revalued at five percent from the previous year. The AMA will request that CMS defer this proposal until after additional information is shared regarding rationale and impact information.
A proposal to replace E/M Visit Complexity add-on HCPCS code G2211 with two new modifiers (MOD2 for ACO participants paid at 32 percent of the E/M base code and MOD1 for all other physicians paid at 16 percent of the E/M base code).
A proposed reduction in payment for Modifier -25 when a separately identifiable E/M office visit is furnished by the same physician (or a physician in the same group practice) on the same day as a 0-, 10-, or 90-day global procedure. The AMA will oppose this policy, which would reduce payments for applicable services such that the most expensive service would be paid 100 percent, and all other surgical procedure(s) or E/M visit(s) would be paid at 50 percent.
Proposed new billing restrictions and payment reductions for remote patient monitoring and remote therapy monitoring services.
Proposed adoption of AMA’s recommendations to update the Maternity Care Services coding structure with increased granularity along with a request for comment on an alternative coding structure to restore the old CPT code descriptors with new G codes. The AMA appreciates CMS’ adoption of our proposed coding changes, which will enhance transparency, but worries the request for comment will create unnecessary confusion.
Various proposed changes to the Shared Savings Program and Ambulatory Specialty Model.
A proposal to sunset the traditional Merit-based Incentive Payment System (MIPS) and transition to MIPS Value Pathways in 2029 despite AMA opposition.
Replacing the current outcome measure requirement with a new core measure requirement for the MIPS Quality Category. The AMA supports shifting away from the outcome measure requirement and will continue to advocate that measurement should be based on clinically meaningful measures, not arbitrary metrics and reporting for the sake of reporting.
Several proposed changes to the MIPS Promoting Interoperability (PI) Category to reduce reporting burden, reflecting longstanding AMA advocacy asks.
Several requests for comment, including on CPT, redesigning primary care payment, transitioning to digital quality measures starting in 2030, and alternative approaches to CMS’ controversial change finalized last year to reduce the indirect PE payment for all services provided in a facility setting.
The American Medical Association (AMA) will submit detailed comments by the Sept. 14, 2026, deadline.
AMA supports House bill focused on physician oversight of AI prior authorization decisions
The deployment of artificial intelligence in prior authorization holds great promise for physicians and patients, so long as it includes proper safeguards. In fact, physicians are hopeful that enhanced use of artificial intelligence will help process health plan mandated prior authorization requests much faster. Despite its tremendous functionality, a highly trained physician must remain the most integral part of the health care decision making process.
In light of this reality, bipartisan members of the House of Representatives are now looking to curb the use of artificial intelligence in prior authorization, especially denials of potentially medically necessary care solely based on technological recommendations. More specifically, Representatives Herb Conaway, MD (D-NJ) and Greg Murphy, (R-NC) introduced H.R. 9734, the Protecting Patients from Automated Denials Act on July 24. Under this legislation, any artificial intelligence assisted prior authorization denial rendered by a Medicare Advantage plan must be reviewed and approved by a qualified physician under the supervision of the plan’s medical director. In addition, physicians must attest that they exercised independent medical judgment and that the subsequent denial was not generated or dictated by artificial intelligence. To ensure compliance, the bill authorizes the Secretary of Health and Human Services to audit and inspect the use of artificial intelligence in prior authorization, including reviewing denial information, internal policies, algorithms, employee practices, and overturn rates.
The American Medical Association was highly involved in the crafting of this legislation and sent a formal letter of support (PDF) to Reps. Conaway and Murphy on July 29. In the press release announcing the legislation, AMA President Willie Underwood III, MD, MSc, MPH, is quoted as stating the following:
“Artificial intelligence is no substitute for a highly trained physician. Medicare Advantage plans should not be permitted to empower AI to make prior authorization decisions, especially denials of medically necessary treatment. We strongly support the provision requiring that physicians oversee any initial prior authorization denial that stems from the use of artificial intelligence. Our patients are being denied care by AI that doesn’t know them, their circumstances, or the nuance of their treatment—and doesn’t care! We applaud Reps. Herb Conaway, MD (D-NJ) and Greg Murphy, MD (R-NC) for introducing the Protecting Patients from Automated Denials Act and our patients will be grateful and healthier when it becomes law.”
Senate Health Committee passes Rural Obstetrics Readiness Act
On July 22, 2026, the Senate Health, Education, Labor and Pensions Committee passed S. 380, the Rural Obstetrics Readiness Act, by a vote of 21-0. The legislation, which is supported (PDF) by the AMA, would provide grant funding to develop, and facilitate access to, an evidence-based program to train practitioners in rural health care facilities to provide emergency obstetric services during pregnancy, labor, delivery or the postpartum period.
The AMA recognizes that it is important to ensure that the larger physician workforce, especially physicians who are often required to provide prenatal and postpartum care in rural facilities, are trained and prepared to provide this medical care. The lack of regular and reliable access to physician specialists and subspecialists, which is common in many rural areas, is of great importance to regular and reliable care. The AMA looks forward to working with bill sponsors and the Senate to see this important piece of legislation across the finish line and signed into law this year.
Proposed rule would create new category of limited excepted benefits for certain fertility services
On July 9, the AMA submitted a detailed comment letter (PDF) for the record to the U.S. Departments of Treasury, Labor, and Health and Human Services (“the Departments”) on the proposed rule, “Excepted Fertility Benefits,” which would create a new category of limited excepted benefits for certain fertility services offered separately from major medical coverage. The AMA expressed support for the departments’ goal of expanding access to evidence-based fertility care but raised concerns that the proposal, as drafted, may not meaningfully increase access to in vitro fertilization (IVF) and other fertility treatments because it does not provide incentives for employers to offer comprehensive coverage.
In its comments, the AMA urged the departments to revise the proposal to encourage broader fertility coverage, eliminate or substantially revise the proposed $120,000 lifetime dollar limit, and focus on expanding access to fertility services that are currently inconsistently covered, particularly IVF and other advanced fertility treatments. The AMA also recommended ensuring that fertility care is delivered through physician-led care teams, and that health plans provide clear, timely, and accessible information regarding covered services, exclusions, and limitations.
The AMA supports efforts to improve access to fertility care and reproductive health services but emphasized that additional policy changes are needed to ensure patients can obtain comprehensive, evidence-based fertility treatment without unnecessary financial or administrative barriers.
More articles in this issue
- Top stories of Advocacy Update: July 2026
- July 31, 2026: State Advocacy Update
- July 31, 2026: Judicial Advocacy Update
