Congress is considering bipartisan legislation that could bring meaningful improvements to Medicare physician payment and reduce some of the financial uncertainty facing spine surgeons.

The Patients First Act (H.R. 9693) proposes several reforms aimed at creating a more stable and predictable Medicare payment system. While the legislation applies broadly to physicians, many of its provisions address issues that have been longstanding priorities for NASS and the spine community.

Among the bill’s most significant provisions is an annual physician payment update tied more closely to inflation, helping Medicare reimbursement better reflect the rising costs of operating a medical practice. The legislation would also reform Medicare’s budget neutrality requirements by increasing the threshold that triggers across-the-board payment reductions, potentially reducing payment volatility when new or revised CPT codes are introduced.

The bill also seeks to improve CMS’ evaluation of new technologies by requiring the agency to revisit payment assumptions when actual utilization differs significantly from projections. This could benefit emerging spine technologies and innovative procedures by promoting more accurate reimbursement over time.

Additional provisions would streamline physician quality reporting through a new physician-led framework and provide greater stability for practices participating in Alternative Payment Models.

For spine surgeons, these reforms could help support independent practice, encourage continued investment in innovation, and create a more predictable reimbursement environment for delivering high-quality spine care.

What Are the Bill’s Chances?
While it is impossible to predict the outcome of any legislation, the Patients First Act appears to have a stronger-than-average chance of influencing Medicare physician payment reform. The bill enjoys bipartisan sponsorship from members of the Congressional Doctors Caucus and has received support from numerous national physician organizations. Just as importantly, it addresses a widely recognized problem: the long-term instability of Medicare physician reimbursement.

Rather than passing exactly as introduced, many observers believe the bill’s core provisions—such as inflation-based physician payment updates and budget neutrality reform—are more likely to be incorporated into a broader Medicare or year-end health care package. NASS will continue to monitor the legislation closely and advocate for policies that ensure spine surgeons and their patients benefit from a more stable, predictable, and innovation-friendly Medicare payment system.

NASS will continue to monitor the progress of the Patients First Act and advocate for policies that ensure Medicare payment systems appropriately recognize the complexity, value, and innovation inherent in spine care.

NASS encourages its members to reach out to your local representatives to support this bill!