Medicare payment reform has momentum. Now Congress needs to act.

By David Tully
Vice President, Government Relations

Family physicians have spent years advocating for a payment system built around the realities of primary care. Now, it appears those calls for change are being heard—though there is still work to be done.

The 2027 Medicare physician fee schedule proposed rule released by CMS earlier this month is a meaningful step forward in supporting primary care. The agency’s proposal includes policies that would strengthen access, support the future primary care workforce and better reflect the comprehensive, continuous care family physicians provide every day.

The proposed rule includes several policies the AAFP has long championed, from greater flexibility for teaching physicians to better recognizing the value of services that are central to comprehensive primary care. CMS is also asking important questions about how Medicare can better support preventive, continuous care.

That is real progress.

It is also only part of the story. The proposed rule still includes reductions to the 2027 conversion factors—a reminder that targeted improvements from CMS cannot fully overcome Medicare’s structural physician payment problem.

That is where Congress comes in. The bipartisan Patients First Act (H.R. 9693) offers a timely opportunity to build on CMS’ work by moving Medicare toward more predictable payment updates and models that better reflect the day-to-day work of primary care.

Taken together, the proposed rule and the Patients First Act show that Medicare payment reform has momentum. The next step is turning that into lasting policy.

The Medicare physician fee schedule has impacts that can be felt across the health care system. Medicaid, TRICARE and commercial insurers often look to Medicare when setting their own rates. When physician services are undervalued, the consequences can reach far beyond one federal program.

These proposals are long overdue. Medicare physician payments declined 33% from 2001 to 2025 when adjusted for inflation, even as practice expenses increased.

Family physicians have bridged that gap while continuing to care for patients, manage chronic disease, provide preventive care and serve as the front door to the health care system. That work deserves a payment system that recognizes its value.

The proposed rule includes several encouraging provisions for family medicine. CMS would expand the primary care exception, giving teaching physicians more flexibility when supervising resident-delivered care. That could improve timely access for patients while supporting the next generation of family physicians.

CMS also would expand payment for primary care-oriented services, including advance care planning and shared medical appointments, that support the conversations, coordination and ongoing management at the core of comprehensive primary care.

Additionally, CMS is asking how to redesign primary care payment to better support preventive, comprehensive care—a discussion that should include family medicine. Still, the conversion factors show why Congress must act: Compared to this year, the 2027 qualifying APM conversion factor would be down 1.19% to $33.1693, and the nonqualifying APM conversion factor would decrease by 1.68%.

Due to the expiration of a congressionally mandated 2.5% increase to both conversion factors, the payment cuts could have been much worse. However, CMS’ valuation updates helped soften those reductions, and family physicians are projected to see a positive 1% impact on total allowed charges in 2027. Family medicine sees real gains in this proposal, but lasting stability still requires congressional reform.

The bipartisan Patients First Act creates a path for Congress to build on CMS’ work and address the instability that continues to strain physician practices. The bill would tie physician payment to an inflationary measure, a critical step toward predictable payment updates that reflect the real cost of running a practice.

It also would create a primary care hybrid payment pilot with a per-member-per-month payment for primary care physicians, though it is limited to independent practices for now. That model better reflects the work family physicians do between visits: coordinating care, managing chronic conditions, following up with patients and maintaining the relationships that help people stay healthy and happy.

That is movement in the right direction. Fee-for-service alone does not reflect the full work of comprehensive primary care, and family physicians need payment models that support prevention, continuity and care management. The bill also aims to reduce administrative burden and support independent practices at a time when consolidation continues to put pressure on physicians and patients.

Medicare payment reform should be bipartisan, because patients in every community across the country rely on family physicians. Congress has an opportunity to strengthen access to care by strengthening primary care.

CMS will review comments before issuing the final 2027 Medicare physician fee schedule.

The AAFP is reviewing the proposal closely and will submit comments on issues that matter to family physicians. We will continue urging CMS to finalize policies that strengthen primary care, improve access and better recognize the value of family medicine.

Congress also has work to do.

The proposed rule shows what CMS can do within its authority. It also shows why that work needs to be paired with long-term legislative reform. Without a reliable annual inflationary update tied to the Medicare Economic Index, practices will continue to face financial pressure that strains the workforce and threatens patient access.

Family physicians can help make that case now. We encourage members to use the AAFP’s Speak Out tool to urge your representatives to support the Patients First Act, which would help modernize Medicare physician payment and better support comprehensive primary care.

AAFP advocacy is stronger when lawmakers hear directly from family physicians. Tell Congress why stable, predictable Medicare payment matters in your practice and what stronger support for primary care would mean for your patients.

The 2027 Medicare proposed fee schedule and the Patients First Act point to the same conclusion: Primary care payment reform is gaining ground, but lasting change will require action from Congress.

CMS has taken important steps to better recognize comprehensive, continuous care. Congress now has a bipartisan opportunity to pair that progress with stable, predictable payment updates that reflect the cost of caring for patients.

The AAFP will keep pressing for reforms that strengthen primary care, support family physicians and protect patient access. You can help by contacting your representatives today and asking them to pass the Patients First Act.