A House Committee on Energy and Commerce Subcommittee on Health hearing Sept. 15 examined bills aimed at reforming Medicare physician payment.
Much of the hearing centered on a shared concern raised by lawmakers and witnesses: that the Medicare physician payment system is contributing to independent practices closing or consolidating, particularly in rural areas.
Witnesses included physician leaders from the American College of Physicians, the American College of Obstetricians and Gynecologists and the American Academy of Dermatology, along with representatives from the Tennessee Pharmacists Association and the Healthcare Sector Coordinating Council.
Here are six takeaways from the hearing:
1. The Patients First Act anchored the payment reform debate.
HR 9693, led by Reps. John Joyce, MD, R-Pa., and Kim Schrier, MD, D-Wash., would mark the first comprehensive update to Medicare physician payment since the Medicare Access and Children’s Health Insurance Program Reauthorization Act took effect in 2015. The bill pairs an inflationary update tied to the Medicare Economic Index minus 1 percentage point with a change to the budget neutrality formula and a five-year hybrid payment pilot letting independent primary care practices layer a per-member fee on top of fee-for-service billing.
“The Patients First Act is critical,” testified American Academy of Dermatology President Murad Alam, MD. Rebecca Andrews, MD, immediate past chair of the board of regents for the American College of Physicians, called it “the first bit of hope I’ve had in a long time for primary care.”
2. Physicians pushed for full Medicare Economic Index parity.
Rep. Raul Ruiz, MD, D-Calif., who is separately pursuing full Medicare Economic Index parity through his own Protecting Medicare for Patients and Providers Act, asked witnesses directly whether they would prefer full MEI reimbursement rather than the “MEI minus one” formula in Patients First. Dr. Alam and Dr. Andrews both indicated they would.
“This is going to leave an unsatisfactory sentiment amongst the provider organizations,” Dr. Ruiz said. “I agree this is a good next step, but this isn’t the fix. We can’t stop until we have the full MEI parity.”
3. Rural obstetric access drove some of the hearing’s most pointed exchanges.
The Rural Obstetrics Readiness Act (HR 1254), led by Rep. Robin Kelly, D-Ill., would fund obstetric emergency training, equipment grants and a pilot “warm line” connecting rural emergency departments with OB-GYNs for real-time teleconsultation. The American College of Obstetricians and Gynecologists’ Eilean Attwood, MD, testified that nearly 150 rural hospitals have stopped or plan to stop providing obstetric services between 2020 and the end of 2026, and described fielding obstetric emergency transfer calls, including one the weekend before the hearing. Rep. Lizzie Fletcher, D-Texas, said more than 700 hospitals closed their maternity wards between 2010 and 2024, and more than 50 maternity wards have closed or announced closure since passage of the 2025 reconciliation law. Rep. Jennifer McClellan, D-Va., shared a constituent’s story of a Farmville, Va., hospital that closed its labor and delivery unit weeks before a patient needed emergency obstetric care.
4. Two cybersecurity bills targeted rural and resource-constrained providers specifically.
The Rural Hospital Cybersecurity Enhancement Act (HR 9908), from Rep. Erin Houchin, R-Ind., and Dr. Schrier, would direct HHS to build a rural hospital cybersecurity workforce strategy and publish training materials. A companion bill, the Health Care Cybersecurity and Resiliency Act, would expand incident-response resources and require breach notifications to include the number of affected individuals. Ms. Houchin cited HHS data reporting 329 healthcare breaches this year involving hacking or IT incidents. Greg Garcia, executive director for cybersecurity at the Healthcare Sector Coordinating Council, cautioned lawmakers against writing specific technical mandates, such as multifactor authentication requirements, into statute.
5. A pharmacist-services bill drew bipartisan consensus.
The Ensuring Community Access to Pharmacist Services Act (HR 3164), led by Rep. Adrian Smith, R-Neb., and Rep. Brad Schneider, D-Ill., has 38 co-sponsors, including 20 Republicans and 18 Democrats. It would let Medicare Part B cover pharmacist-provided testing and treatment for common respiratory illnesses — services already covered by Medicaid and commercial health plans in 28 states, including Tennessee, but not by Medicare.
“That’s a problem,” Tennessee Pharmacists Association CEO Anthony Pudlo, PharmD, said. “And 3164 is really ultimately a cost solution for Medicare” by diverting patients from higher-cost emergency department visits.
6. Consolidation was the hearing’s throughline.
Multiple members tied declining Medicare reimbursement directly to the shrinking pool of independent physicians. Dr. Joyce cited data showing only 1 in 5 doctors remains unaffiliated with a hospital system or large corporate entity; Rep. Greg Landsman, D-Ohio, put the figure at 82% of physicians now employed by a hospital, insurer or private equity firm.
“The impact on patient care will be fewer places to find a doctor, much longer waits, dramatically worsened disease processes, advanced cancers, deaths that are avoidable,” Dr. Alam said.
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