ACOOG signs on to the Patients First Act
acoog advocacy
ACOOG signs on to the Patients First Act.
H.R. 9693 rewrites how Medicare pays physicians. Here is what the bill changes, what it leaves out, and why it reaches care Medicare never pays for.
The American College of Osteopathic Obstetricians and Gynecologists (ACOOG) has added its name in support of the Patients First Act of 2026, joining the American Osteopathic Association (AOA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Psychiatric Association (APA), and the American Medical Association (AMA) behind the most substantial Medicare physician payment bill since 2015.
Representatives John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA) introduced the bill on July 15, 2026. All three chair the Republican or Democratic Doctors Caucuses. All three practice medicine. H.R. 9693 rewrites the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) after a decade of experience with them.
Four changes worth reading
The reforms organized medicine has asked for since 2015, in one bill.
A permanent inflation update
The annual Medicare physician update would track the Medicare Economic Index, the government's own measure of practice cost growth, built into the payment baseline. Practices would stop waiting on year-end patches from Congress to avoid a cut. Adjusted for inflation, Medicare physician payment fell 33 percent between 2001 and 2025.
Budget neutrality reform
The bill folds in the Provider Reimbursement Stability Act (H.R. 8163). It raises the $20 million adjustment threshold set in 1989, requires the Centers for Medicare and Medicaid Services (CMS) to correct its own utilization misestimates, and caps how far the conversion factor swings year to year. Obstetrician-gynecologists have absorbed those offsets for years without any change in their own work.
POINTS replaces MIPS
The Patient Outcome Improvement National Tabulation System retires the Merit-based Incentive Payment System. A task force with a clinician majority, drawing on specialty societies, builds the quality measures. Maximum penalties drop sharply. For a specialty scored on metrics designed for primary care panels, physician-led measure development is the operative provision.
Rural and independent practice support
The bill freezes the alternative payment model Qualifying Participant threshold at 50 percent, extends and raises the work geographic practice cost index floor benefiting rural areas and 34 entire states, and funds a five-year hybrid payment demonstration for independent primary care practices, exempt from budget neutrality.
What the bill does not do for OB/GYNs
Two gaps ACOOG members should hold in view.
The primary care demonstration reaches independent and private primary care practices only. Most osteopathic OB/GYNs fall outside it. The per-member-per-month structure it tests is worth watching, since CMS asked for comment this summer on redesigning primary care payment more broadly, but the pilot itself will not reach the ACOOG membership directly.
The bill also leaves the 2027 fee schedule untouched. CMS proposed a conversion factor cut of 1.68 percent for physicians outside alternative payment models and 1.19 percent for those inside them, effective January 1, 2027.
Watch the modifier 25 proposal
CMS proposed paying only 50 percent for additional procedures or evaluation and management visits furnished on the same day as a global procedure under modifier 25. Gynecologic surgeons who see a patient and operate in the same encounter would feel the reduction immediately. Comments on the proposed rule close September 14, 2026.
Why Medicare rates decide non-Medicare care
Medicare sets the benchmark other payers follow. State Medicaid programs and commercial plans build their fee schedules off Medicare relative values, so a fee schedule cut reaches obstetric and gynecologic care delivered to patients who will never enroll in Medicare.
Payment stability also determines staffing. Practices operating on a baseline eroded by inflation hire fewer nurses, defer technology, and sell to hospitals and payers. Consolidation follows, and in obstetrics it shows up as a closed labor and delivery unit and a longer drive for a rural patient in labor.
What ACOOG members should do
Three steps, none of which take more than a few minutes.
Ask your representative to cosponsor H.R. 9693
The sponsors need bipartisan volume to move the bill out of committee. Find your representative at commoncause.org.
Comment on the 2027 fee schedule by September 14
The modifier 25 proposal and the maternity care coding revisions both warrant OB/GYN input. CMS counts specialty comments.
Track the bill
Follow the text and cosponsor list at congress.gov.
A letter you can send today
Copy the text below, add your own detail in the bracketed spots, and send it through your representative's contact form.
Subject: Please cosponsor H.R. 9693, the Patients First Act
Dear Representative [NAME],
I am a board-certified osteopathic obstetrician-gynecologist practicing in [CITY, STATE], and I am writing as your constituent to ask you to cosponsor H.R. 9693, the Patients First Act of 2026.
Medicare physician payment has fallen 33 percent since 2001 once inflation is counted. My practice absorbs that gap every year while rent, malpractice premiums, staff salaries, and supply costs rise. [ADD ONE SENTENCE ABOUT YOUR PRACTICE: a position you have not been able to fill, a piece of equipment you have deferred, a service line you have reduced, or the distance your patients now drive for obstetric care.]
The Patients First Act addresses the causes rather than the symptoms. It ties the annual Medicare update to the Medicare Economic Index and builds it into the payment baseline, ending the yearly scramble for a temporary patch. It reforms budget neutrality rules written in 1989, so one specialty's payment increase no longer forces a cut across every other specialty. It replaces the Merit-based Incentive Payment System with a quality program built by a clinician-majority task force, which means physicians and specialty societies define what gets measured. It extends the work geographic practice cost index floor that supports rural practices in 34 states.
This reaches well past Medicare. State Medicaid programs and commercial insurers set their rates off Medicare relative values, so the fee schedule shapes payment for obstetric and gynecologic care delivered to patients of every age. When payment falls behind cost, independent practices sell or close. In obstetrics that shows up as a shuttered labor and delivery unit and a longer drive for a patient in labor. [IF APPLICABLE: NAME A HOSPITAL OR UNIT IN YOUR DISTRICT THAT HAS CLOSED OBSTETRIC SERVICES.]
Representatives John Joyce, MD, Greg Murphy, MD, and Kim Schrier, MD wrote this bill as practicing physicians, and it has bipartisan support. The American Osteopathic Association, the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, and my own specialty college, the American College of Osteopathic Obstetricians and Gynecologists, all support it.
Please add your name as a cosponsor of H.R. 9693. I am glad to talk with your health staff about what this bill would mean for practices and patients in our district.
Thank you for your time.
Sincerely,
[YOUR NAME], DO
[PRACTICE NAME]
[STREET ADDRESS, CITY, STATE, ZIP]
[EMAIL AND PHONE]
Make one edit before you send
Congressional staff sort identical form letters into a tally and read the personal ones. The bracketed sentence about your own practice is the part that earns a reply. Include your home address so the office confirms you live in the district.
One message moves a cosponsor.
Tell your representative what a decade of flat payment has done to your practice and your patients.
Sources
H.R. 9693, Patients First Act of 2026, 119th Congress, congress.gov. American Osteopathic Association, "Leading physician groups: Patients First Act addresses longstanding payment challenges," July 20, 2026. American Medical Association, National Advocacy Update, July 31, 2026. American Academy of Family Physicians, "Patients First Act Signals Commitment to Modernizing Primary Care Payment," July 15, 2026. Centers for Medicare and Medicaid Services, CY 2027 Medicare Physician Fee Schedule proposed rule, July 14, 2026.