Patients First Act Will Help Preserve Access to Essential Office-Based Care

The Office-Based Facility Association (OBFA) strongly supports the introduction of H.R. 9693, the bipartisan Patients First Act by Reps. John Joyce, M.D. (PA-13), Greg Murphy, M.D. (NC-03), and Kim Schrier, M.D. (WA-08). The legislation represents an important step toward strengthening Medicare physician payment and preserving patient access to office-based procedural services.

Patients often rely on timely access to highly specialized physicians who provide lifesaving office-based procedural care. Years of inadequate Medicare payment updates have placed increasing financial strain on outpatient physician practices, making it more difficult to sustain these essential services. Title 1 of the Patients First Act would replace the existing Medicare Physician Fee Schedule (PFS) growth rate with an inflationary update based on Medicare Economic Index (MEI) at an equivalent of MEI -1%. This provision would help to stabilize office-based procedural care in a way that better reflects the cost of delivering care.

Preserving outpatient physician practices is particularly important for patients who require ongoing, coordinated access to specialized outpatient services. As physician consolidation accelerates, patients face fewer choices, longer wait times, and greater barriers to receiving care close to home—especially in rural and underserved communities. By helping to stabilize outpatient physician practices, the Patients First Act supports continued access to high-quality, patient-centered office-based procedural care.

Other provisions of the Patients First Act would address ongoing concerns with other PFS-related issues, including quality metrics, value-based programs, and underlying budget neutrality provisions. Title II of the bill would transition the MIPS (Merit-based Incentive Payment System) program over a five-year period into a Patient Outcome Improvement National Tabulation System (POINTS). Title III would update and improve the Alternative Payment Model program. Title IV would reform underlying budget neutrality provisions in the PFS by 1) requiring retroactive adjustments in the conversion factor based on utilization estimates to reconcile differences, 2) requiring once every 5 years the Secretary update PFS direct cost calculations and 3) and limiting year to year variance of the conversion factor outside of other existing provisions of law to 2.5%.

The Patients First Act represents an important first step toward restoring predictability to Medicare physician payment by replacing recurring short-term fixes to the PFS conversion factor with an inflation update based on the Medicare Economic Index. As we have seen, however, such reform addresses only one dimension of a broader structural challenge within the Medicare Physician Fee Schedule (PFS). An ongoing concern is that the PFS now attempts to finance both:

• Physician professional services in all sites of service (hospital, ASC, office) and

• Advanced technical infrastructure required to deliver modern office-based procedural care

Importantly, while an inflation-based update to the Physician Fee Schedule will help to stabilize reimbursement for physician work, it will not address underlying, long-standing issues surrounding the dilution of the PFS from advanced medical technologies migrating from the hospital setting to the office-based setting. To address such concerns, OBFA believes the PFS needs structural reform and, fortunately, a better architecture for office-based practice expense already exists.

Medicare already maintains a mature reimbursement methodology for ambulatory practice expense: the Hospital Outpatient / Ambulatory Surgical Center Prospective Payment System (HOPPS). HOPPS data are collected annually, audited, nationwide in scope, transparent, and routinely updated. Rather than continuing to reimburse for office-based practice expense through the Physician Fee Schedule, Medicare should pay for office-based practice expense consistent with how it pays for other ambulatory practice expenses.

Taken together, OBFA believes these provisions would significantly improve patient access to office-based procedural services. OBFA appreciates the bipartisan leadership behind the Patients First Act and urges Congress to move quickly to enact this legislation. For more information, visit https://www.obfassociation.org.