Medicare Keeps Cutting Physicians. Patients Pay the Price.
Every year Medicare raises payments to hospitals. Every year physicians face another cut. Congress can end this cycle by passing H.R. 9693, the Patients First Act of 2026, and Texas patients and physicians can help make it happen.
You Can’t Opt Out: Why Every Orthopaedic Surgeon Has to Engage in Public Policy
Patients and physicians have no choice but to engage in the public policy process in Washington, D.C. Congress must hear from you, the electorate.
Otherwise, Congress will make decisions about Medicare that harm patients — like the dramatic physician payment cuts Medicare has proposed for 2027. Staying silent is a choice, and patients pay for it.
Watch on YouTubeHospitals Receive Annual Increases. Physicians Receive Cuts.
While hospitals and other parts of the health care system consistently receive positive payment updates from Medicare every year, perhaps the most important segment of the health care system — physicians — has been cut by Medicare the past few years.
This is due to an antiquated formula passed by Congress decades ago. It forces physicians into a Medicare payment system that results in cuts, while hospitals and other segments of the health care delivery system receive payment increases every year.
Cumulative change since 2000
2000 through 2027 proposed. Data: Adam Bruggeman, MD. Sources: Medicare PFS and OPPS rules, Medicare Economic Index.
Up to 20%
Medicare’s CY 2027 Physician Fee Schedule proposes cuts of up to 20% for joint replacement surgery.
When practices can no longer afford to see Medicare patients, seniors lose access to the orthopaedic surgeons they depend on. They wait longer, travel farther and struggle to find care close to home.
Who is the most important part of the health care delivery system?
The Physician.
Patients can’t receive care without physicians.
More Than Two Decades of Falling Behind
These four charts track what Medicare pays physicians against what it pays hospitals and against the rising cost of keeping a practice open.
Medicare payment has fallen behind the cost of practicing medicine
Since 2000, hospital outpatient payments have risen 97.7% and practice costs have risen 71.0%. Medicare physician payment has fallen 10.3%.
Physician payment diverged sharply from the cost of practicing medicine
Measured against practice-cost inflation since 2008, hospital outpatient payment is 11.4 points ahead and hospital inpatient payment is 7.0 points ahead. The physician fee schedule is 53.5 points behind.
Medicare physician payment since 2000
Under the 2027 proposal, Medicare would pay roughly 40% less for a total knee or total hip replacement than it did in 2000 — before accounting for a single year of inflation.
Medicare physician payment relative to practice-cost inflation
Adjusted for the rising cost of running a practice, payment for hip and knee replacement has fallen more than 100 points behind since 2000. Shoulder replacement and ACL reconstruction trail by about 90.
Fewer Independent Physicians Means Fewer Choices for Patients
Decreasing Medicare payments to physicians are one of the prime reasons physicians are leaving private practice to work for hospitals, other entities and even health plans — some health plans now employ physicians directly.
The result is consolidation. And consolidation means fewer physician choices for patients.
Share of physicians in private practice, 2012 to 2024
Fewer physicians in private practice in 2024 than in 2012, even as the physician workforce grew
Source: American Medical Association, Physician Practice Benchmark Survey, 2024.
Patients deserve a healthy health care ecosystem
It is vital that patients, physicians and hospitals have a healthy health care ecosystem with a wide variety of physician options.
Private practice
Independent, physician-owned practices rooted in the communities they serve.
Hospital models
Physicians employed by or aligned with hospitals and health systems.
Academic medicine
Teaching institutions that train the next generation of physicians.
H.R. 9693: The Patients First Act of 2026
Introduced July 15, 2026 by Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC) and Kim Schrier, MD (D-WA), the bipartisan Patients First Act would fix the formula that keeps cutting Medicare payment to physicians.
We are asking every Texas member of Congress to cosponsor it.
Section by section
Title I: Strengthening Reimbursement and Patient Access
Replaces the existing growth rate with an inflation-based update of the MEI with one point subtracted, or MEI-1.
Creates a new five-year demonstration project where CMS would be tasked with establishing a hybrid payment structure, blending traditional FFS with per-member-per-month (PMPM) capitated payments for primary care providers.
For a five-year period, in years in which the MEI is above 2% (defined as high inflationary), requires the Secretary to adjust the Work Geographic Index floor by an additional .025 for rural GPCIs or by .02 for all other GPCIs.
Title II: POINTS
Rebrands the FFS QPP program to replace MIPS after the five-year transition period as the Patient Outcome Improvement National Tabulation System (POINTS).
Establishes three performance categories for metric development under POINTS, maintaining Quality and Resource Use from MIPS and creating a new Care Efficiency category.
Requires CMS to establish a new Quality Care Reform Task Force to develop and implement new QPP reporting metrics for the POINTS system.
Reduces payment penalties in MIPS from +/-9% to +/-2% during the transition period of the rework of metrics and establishment of POINTS to reduce fiscal burden on providers.
Sets up a pathway for CLDRs to receive approval from CMS to operate for three years at a time should they meet the statutory requirements, and to renew for unlimited three-year periods.
Creates a mechanism for CLDR/QCDRs to receive access to claims-level data from CMS for research, quality of care measurement and reporting.
Reduces burden and barriers in the Medicare Appropriate Use Criteria (AUC) program.
Clarifies ownership and IP rights for metrics and services developed by CLDR/QCDRs for the purpose of POINTS.
Title III: APM Improvement
Freezes current APM participation thresholds for three years.
Establishes a statutory requirement for a formal notice and comment period for all mandatory models and when a model is ended early or materially changed.
Requires a GAO/CMMI/MedPAC report to Congress on existing barriers to specialty participation in value-based models, with specific recommendations to reduce them.
Title IV: Physician Payment Improvements
Strikes the current $20 million threshold, replaces it with $57.64 million and indexes it to MEI every five years.
Requires retroactive adjustments in the conversion factor based on utilization estimates to reconcile differences.
Requires that once every five years the Secretary update the direct cost calculations and valuations in consultation with the relevant stakeholders.
Limits year-to-year variance of the conversion factor, outside of other existing provisions of law, to 2.5%.
Summary adapted from Rep. John Joyce’s Patients First Act section-by-section.
Five Texas Members of Congress Are Cosponsors
These Texans have stepped up for patients and physicians. If one of them represents you, send a quick note of thanks.
Cosponsor list as of Fall 2026. See the current Texas cosponsors on Congress.gov
Patients and Physicians: It’s Time to Take Action
Members of Congress listen to the electorate. A few minutes from you — a patient, a physician, a practice manager, a family member — is what moves a member of Congress to add their name to H.R. 9693.
Find your member of Congress
Not sure who represents you? Go to house.gov and enter your ZIP code in the “Find Your Representative” lookup.
- If your member of Congress is already a cosponsor, thank them.
- If not, ask them to cosponsor H.R. 9693.
- Contact both U.S. Senators too and ask them to support Medicare physician payment reform.
Write your message in your own words
Use the talking points below as a starting place. Pick the ones that matter most to you, add your own story, then click your member’s box at the bottom of this page to open their contact form. Prefer to call? Each box lists their Washington, D.C. office number.
Talking points for patients
- Please cosponsor H.R. 9693, the Patients First Act of 2026, and take action on this critical issue before the year ends.
- Every year Medicare gives hospitals and other parts of the health care system an annual payment update. Physicians receive cuts.
- Health care can’t work without physicians. I can’t receive care without my orthopaedic surgeon.
- Medicare is proposing cuts of up to 20% for hip, knee and shoulder replacements beginning in 2027.
- Medicare cuts are pushing independent physicians to sell their practices to hospitals, large corporations and even health plans.
- That consolidation leaves Medicare patients like me with fewer choices, longer waits and longer drives for care.
Talking points for physicians
- Please cosponsor H.R. 9693, the Patients First Act of 2026, and take action on this critical issue before the year ends.
- Hospitals and other segments of health care receive an annual payment update from Medicare. Physicians receive cuts.
- Since 2000, Medicare physician payment has fallen 10.3% while the cost of running a practice has risen 71.0%.
- An antiquated formula Congress passed decades ago locks physicians into a payment system that produces cuts year after year.
- These cuts are one of the prime reasons physicians are leaving private practice for hospitals, other entities and health plans. Only 42.2% of physicians were in private practice in 2024, down from 60.1% in 2012.
- Consolidation reduces competition, raises costs and destroys patient choice in Medicare.
- Health care can’t work without physicians. Patients can’t receive care without us.
Why talking points instead of a form letter?
Policymakers want to hear from you in your own words. Medicare says so directly: a single, well-supported comment may carry more weight than a thousand form letters.
Congressional offices work the same way. Identical messages are tallied and filed. Personal stories are read, remembered and repeated in meetings where decisions are made.
That’s why TOA gives you suggestions rather than a script. Start with the points above, then add what only you can say.
U.S. Senators — represent every Texan
U.S. House — by district
TX-23 is vacant following Rep. Tony Gonzales’ resignation; a special election is pending. Most contact forms require a Texas address in that member’s district.