- Energy and Commerce hearing highlights Patients First Act
- AMA urges CMS to significantly modify proposed 2027 physician payment policies
- Preventive Health Savings Act passes House Budget Committee
- AMA reiterates strong support for federal student loan relief legislation
- HHS event highlights major expansion of the ACCESS model
- CMMI model to help Medicare-eligible individuals make better-informed coverage choices
- Clarifying “legitimate medical purpose” under the Controlled Substances Act
- CMS seeks input regarding MIPS Value Pathways (MVPs)
- AMPAC hosts 2026 Campaign School in Washington, D.C.
- More articles in this issue
Energy and Commerce hearing highlights Patients First Act
This week, the House Energy and Commerce Subcommittee on Health held a legislative hearing focused on strengthening the Medicare physician payment system, with significant attention devoted to the Patients First Act (H.R. 9693). The comprehensive, bipartisan legislation, introduced by Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA), would replace the annual cycle of Medicare physician payment cuts and temporary congressional patches with a system that is more stable, predictable, and reflective of the actual costs of delivering care.
The hearing comes at a critical time for Medicare physician payment reform. When adjusted for inflation in practice costs, Medicare physician payment has fallen approximately 33% since 2001, and physicians remain the only Medicare provider type that does not receive an annual payment update tied to inflation. These mounting financial pressures are particularly challenging for small, rural, and independent practices and increasingly threaten patients' timely access to physician care.
The Patients First Act would address these longstanding structural problems through several major reforms. The legislation would establish a permanent annual Medicare physician payment update linked to the Medicare Economic Index, modernize outdated budget neutrality policies to prevent destabilizing across-the-board cuts, replace the Merit-based Incentive Payment System (MIPS) with a streamlined, clinician-driven quality program that reduces penalties and administrative burden, and preserve meaningful incentives for physicians participating in alternative payment models. These reforms closely align with the Characteristics of a Rational Medicare Physician Payment System, a framework endorsed by more than 120 state medical associations and national medical specialty societies.
Ahead of the hearing, the AMA joined state medical associations representing physicians in every state and the District of Columbia in sending a letter (PDF) to Reps. Joyce, Murphy and Schrier strongly supporting the Patients First Act. The physician community urged lawmakers to cosponsor the legislation and emphasized its importance in securing a sustainable Medicare program for both patients and physicians.
The Energy and Commerce Committee's consideration of the Patients First Act represents an important step forward in the AMA's longstanding effort to achieve comprehensive Medicare physician payment reform. The AMA will continue working with the bill's bipartisan sponsors, committee leadership, state medical associations, and national medical specialty societies to build support for H.R. 9693 and advance a Medicare payment system that provides physicians with greater stability while protecting patients' access to care.
AMA urges CMS to significantly modify proposed 2027 physician payment policies
In a 171-page comment letter (PDF) responding to proposed regulations for the 2027 Medicare physician payment schedule, the AMA strongly recommends that CMS change the proposed policies before issuing its final regulations. The letter states particular concern about the following proposals:
Modifier -25: CMS proposes to slice payment in half when Evaluation and Management services are reported on the same day as a procedure with a global period. AMA comments urge CMS not to finalize this policy and instead address any genuine overlaps in services provided the same day on a code-specific basis.
Practice expense methodology: The four different changes that CMS proposes to this methodology lack key details that would be needed to evaluate them and produce significant payment redistributions. The AMA asks CMS to defer them, provide the missing analyses, and phase-in any change over multiple years.
Remote monitoring: In response to proposals to sharply reduce payment rates, create new G-codes in place of CPT, and only allow practice employees to provide remote monitoring, the AMA urges that the coding and payment changes be paused while data is gathered and that the employed staff proposal be withdrawn.
Ambulatory Specialty Model: The AMA is concerned that implementing this model under either the policies finalized in last year’s rule or those currently proposed would have serious negative consequences for Medicare patients with heart failure or low back pain and their physicians.
MIPS Value Pathways (MVPs): Despite the numerous problems with the current Merit-based Incentive Payment System (MIPS), the AMA strongly opposes sunsetting it and mandating reporting through MVPs starting in 2030. MVPs are not built around the specific conditions that physicians treat, and critical gaps remain.
Alternative Payment Model (APM) incentives: The AMA is urging CMS not to finalize its proposal to only apply APM incentives and the higher APM conversion factor to claims associated with an Advanced APM entity. This change is inconsistent with CMS’ statutory authority and would cause unnecessary complexity and confusion.
AMA comments also addressed the proposed 2027 conversion factors and urged the Administration to support H.R. 9693, the Patients First Act (PDF), which would provide permanent, inflation-based payment updates linked to the Medicare Economic Index (MEI).
Preventive Health Savings Act passes House Budget Committee
The legislative effort to enable Congress to pass more preventive healthcare bills took a major step forward on Sept. 16 following the House Committee on Budget unanimously passing H.R. 4464, the Preventive Health Savings Act. Introduced by Reps. Jay Obernolte (R-CA), Scott Peters (D-CA), Diana DeGette (D-CO) and Buddy Carter (R-GA), this bipartisan legislation enables leaders in Congress to request the Congressional Budget Office (CBO) to provide an estimate of the long-term health savings that derive from preventive health initiatives. Chairman Jody Arrington (R-TX) and Ranking Member Brendan Boyle (D-PA) held a markup and officially reported the bill out the House Budget Committee by a vote of 29-0.
Under H.R. 4464, the chair and ranking member of the budget and health-related committees in the House or Senate are permitted to jointly request a CBO analysis of the two 10-year periods, beyond the existing initial 10-year window. CBO’s use of a single 10-year “scoring window” often results in the majority of preventive health services and screening procedures to be assessed as a short-term increase to the Medicare program simply because they are new types of care available to patients. This myopic economic analysis, however, misses the potential for preventive healthcare to actually save money over the long-term due to their ability to catch diseases and other conditions at its earliest stage. Early detection or diagnosis enables physicians to actually treat or cure many conditions, thus leading to long-term, downstream savings that are often not captured by current CBO assessment methodologies.
AMA is a long-term supporter (PDF) of this legislation and sent two letters endorsing H.R. 4464 in August (PDF) and September (PDF) 2025, respectively. The AMA will continue to push the House and Senate to enact this important, bipartisan bill before the conclusion of the 119th Congress.
AMA reiterates strong support for federal student loan relief legislation
The AMA continues to tout the importance of Congress enacting federal legislation to lessen the burden of student loan debt on medical students. In fact, the AMA joined more than 40 national medical specialty societies and other physician organizations in a letter (PDF) to the chairs and ranking members of the House Education and Workforce and Senate Health, Education Labor and Pensions (HELP) Committees requesting Congress advance H.R. 2028/S. 942, the Resident Education Deferred Interest (REDI) Act.
As stated in the letter, “The REDI Act would restore the ability for eligible borrowers who are enrolled in accredited medical and dental internship or residency programs to defer the interest accrual on their federal student loans during this required period of training.” While the bill does not authorize any forgiveness of outstanding loan principal, the ability to delay any interest on existing federal loans will enable more individuals from diverse economic backgrounds to attend medical school, complete residency programs, and ultimately become physicians.
The letter also points out that recent changes to federal student loan policy, following the enactment of H.R. 1, the One Big Beautiful Bill Act, increased the urgency for enactment of the REDI Act. The legislation was introduced by Sens. John Boozman (R-AR) and Jacky Rosen (D-NV) in the Senate, while Reps. Brian Babin, DDS (R-TX) and Chrissy Houlahan (D-PA) are the lead sponsors in the House of Representatives. AMA letters of support were previously sent in support of the House (PDF) and Senate (PDF) bills in 2025, and the AMA will continue to work with leaders in both chambers to expeditiously enact the REDI Act prior to the conclusion of the 119th Congress.
HHS event highlights major expansion of the ACCESS model
At a Sept. 15 U.S. Department of Health and Human Services (HHS) event, Building a Healthier America: CMS ACCESS and a New Chapter in Health Innovation, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of the CMS Innovation Center’s Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model and reframed it as a broader payment reform effort rather than a single pilot program. Under ACCESS, CMS pays outside organizations, such as digital health companies and virtual-first care providers, to help people with original Medicare manage chronic conditions between doctor visits using tools like apps, remote monitoring and health coaching. Rather than paying these organizations for each service, CMS ties their payment to how much a patient's health actually improves. HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and Innovation Center Director Abe Sutton were among the speakers. An event recording and the CMS press release are available online.
Beginning in spring 2027, CMS will add five new or expanded conditions to the model: heart failure, COPD, substance use disorders (including co-occurring depression and anxiety), tobacco cessation and expanded chronic musculoskeletal (MSK) support. These join the existing early cardio-kidney-metabolic, cardio-kidney-metabolic, musculoskeletal and behavioral health tracks, extending the model’s reach to roughly three in four people in original Medicare (Medicare Advantage enrollees are not eligible). The model remains voluntary and referral-based, supports virtual care, remote monitoring and connected devices between visits, and is designed to integrate with, not replace, the existing care team. A participant directory is now live at Medicare.gov/ACCESS.
Payment to the participating organizations (the app developers, virtual care providers, and health technology firms) remains outcomes-based, tying dollars to measurable health improvement, rather than paying per service. CMS also announced a multi-payer alignment effort under which payers covering about 165 million Americans across Medicare Advantage, Medicaid, and commercial coverage have pledged to adopt ACCESS-aligned payment. This is the principal mechanism by which CMS intends the model to extend beyond Medicare.
Separate from the outcome-based payments participating organizations receive, CMS has established a co-management payment (CMP) that compensates the patient’s own physician for reviewing the progress report the ACCESS organization shares about that patient’s care and performing at least one care coordination activity (e.g., reconciling medications, updating the problem list, or documenting agreement or disagreement with the ACCESS recommendations). CMS pays approximately $30 per instance through three condition-based billing codes, plus $10 for initial onboarding and device setup, payable up to three times per year per beneficiary per track. Critically, the CMP is additive—it does not replace or affect existing billing for office visits or other covered services, carries no beneficiary cost-sharing, and requires documentation of the review.
AMA proposes CMMI model to help Medicare-eligible individuals make better-informed coverage choices
On Sept. 16, the AMA asked the Center for Medicare & Medicaid Innovation (CMMI) to test a new Medicare Informed Choice Model aimed at helping individuals who are approaching age 65 and becoming eligible for Medicare to make better-informed coverage decisions. The model would test a package of reforms to the Medicare enrollment process to see whether they help individuals select coverage that better aligns with their healthcare needs and financial circumstances. Ultimately, the model would test if these reforms improve quality of care and reduce Medicare spending.
Under the AMA proposed model, CMMI would test four complementary interventions:
Earlier enrollment outreach and guidance at key decision points, delivered through Medicare information provided 12, six and three months before people are first eligible to enroll in Medicare, as well as Social Security communications and targeted guidance at key points in the enrollment process.
Standardized MA benefit designs and personalized, curated coverage options that make plans easier to compare while preserving access to all available options.
Clearer, more comparable information through Medicare Plan Finder, with side-by-side comparisons of total costs under traditional Medicare and Medicare Advantage (MA) and plan-level information on prior authorization, network breadth, provider directory accuracy, and the scope and limitations of supplemental benefits.
Expanded and more consistent access to impartial enrollment assistance through State Health Insurance Assistance Programs (SHIP), with prescheduled appointments, stronger counselor training, and standardized counseling scripts and decision-support protocols.
The proposal advances longstanding AMA policy to improve Medicare education and help people make better-informed coverage decisions. Most recently, at the 2026 Annual Meeting, the House of Delegates called on CMS to develop a comprehensive strategy to educate people approaching Medicare eligibility and during annual enrollment periods about key factors that affect choices between traditional Medicare and MA. Individuals often make these decisions without adequate information about physician access, potential cost-sharing liability, Medigap implications and other consequential differences among their options, and the policy calls for the federal government to take a stronger role in Medicare education.
The recent AMA policy builds on several policies adopted previously aimed at ensuring individuals have the information they need to evaluate their Medicare options. Specifically, the AMA has urged CMS to:
Improve MA provider-directory accuracy and provide information (PDF) through Medicare Plan Finder on network size, accessibility and stability
Provide better education about differences in benefits and provider panels and strengthen support for federal and state health insurance assistance programs
Educate individuals about the Medigap implications of enrolling in MA
Require public reporting of prior authorization requirements and outcomes
The proposed Medicare Informed Choice Model would put many of these policies into practice, helping to promote more informed coverage decisions, greater coverage stability and continuity of care, and lower costs for patients and the Medicare program.
Clarifying “legitimate medical purpose” under the Controlled Substances Act
The AMA this week urged (PDF) the U.S. Drug Enforcement Administration (DEA) to provide clearer guidance for physicians and federal investigators about the factors used during investigations of physicians that involve enforcement of the Controlled Substances Act (CSA). In a letter to DEA Administrator Terrance C. Cole, AMA CEO John Whyte, MD, MPH, further encouraged the DEA to rely on state medical board definitions for “the practice of medicine” to guide investigations into whether a practitioner has acted without a legitimate medical purpose.
“Prescriptions that are issued as a pretext for drug trafficking, personal misuse, or other unlawful conduct do not represent the practice of medicine and should be addressed appropriately,” wrote Dr. Whyte. “At the same time, the AMA believes that enforcement activity must carefully distinguish unlawful conduct from clinical practice that is lawful, patient-centered, and consistent with the physician’s professional obligations.”
Dr. Whyte further emphasized that “Physicians must be able to exercise sound medical judgment without fear that clinically appropriate care will later be second-guessed under an undefined federal standard.”
CMS seeks input regarding MIPS Value Pathways (MVPs)
CMS is conducting an MVP adoption survey and is seeking input from practices on whether they have reported an MVP for Payment Year (PY) 2025, are preparing to report for PY 2026, or have not yet begun adopting an MVP. The AMA encourages physicians and practices to complete the survey, especially if they are concerned with CMS’ proposal in the 2027 Medicare Physician Fee Schedule Proposed Rule to sunset traditional MIPS and require MVP reporting-only starting in 2029. The AMA will continue to strongly advocate against mandatory MVP reporting and the need to maintain traditional MIPS along with reforms to the program to reduce administrative burden and make the program more relevant.
Participation in the survey is voluntary and confidential. Responses will be reported to CMS in aggregate to protect the identity of individuals, groups, and entities. Eligible clinicians may receive Improvement Activity (IA) credit for completing the survey. Take the survey by visiting: The MVP Adoption Survey. Please contact [email protected] with any questions.
Individuals, groups, subgroups and APM Entities that wish to report an MVP for the 2026 performance year must register by Nov. 30, 2026, at 8 p.m. ET.
AMPAC hosts 2026 Campaign School in Washington, D.C.
A tight race in a swing district was once again the backdrop for AMPAC’s annual Campaign School on Sept. 10-13 at the AMA offices in Washington, D.C. Seventeen participants from across the country worked on the congressional “campaigns” of either the Democrat or Republican candidate in a simulated campaign. The participants included physicians, residents, medical students and medical society staff.
Over the course of the program, participants heard from political experts on both sides of the aisle on topics including campaign strategy, vote targeting, social media, paid advertising, public speaking and more. Taking what they learned in these sessions, participants then applied what they learned in real life breakout exercises where they had to work together as a team to create radio ads, respond to a simulated campaign crisis and write and deliver a speech in support of their candidate.
The Campaign School is one of AMPAC’s two annual programs, along with the Candidate Workshop, and is open to AMA member physicians, residents, students, spouses, and state and specialty medical society staff who are interested in becoming more involved in the political process —whether that means a run for office themselves or want to learn the skills to be a valuable asset to the campaign of a champion of medicine.
Dates for the 2027 Candidate Workshop and Campaign School have not been finalized, but please visit: www.ampaconline.org to learn more about these programs.
More articles in this issue
- Top stories of Advocacy Update: September 2026
- Sept. 18, 2026: State Advocacy Update
- Sept. 18, 2026: Judicial Advocacy Update
