Congress Just Introduced a Bill That Pays Primary Care Doctors Per Member Per Month

Legislation by DPC Insider
#legislation#Medicare#MACRA#Patients First Act#PMPM#physician reimbursement#primary care
Sources: ACP Applauds the Introduction of the Patients First Act of 2026 · Drs. Joyce, Murphy, and Schrier Introduce Bipartisan Patients First Act · Patients First Act Aims to Reform Physician Reimbursement

Three physician-members of Congress introduced a bill on July 15 that would pay primary care doctors a per-member-per-month fee through Medicare.

The Patients First Act of 2026, sponsored by Reps. John Joyce (R-PA), Greg Murphy (R-NC), and Kim Schrier (D-WA), creates a five-year hybrid payment pilot for primary care, ties the Medicare physician fee schedule to a medical inflation index, and replaces the Merit-Based Incentive Payment System (MIPS) with a new physician-led quality framework. All three sponsors are physicians and serve as chairs of their respective parties’ Doctors Caucuses.

If you’ve been in DPC for any length of time, the per-member-per-month structure should sound familiar. DPC practices have run on it for over a decade. What’s new is that Congress is now proposing to test it inside Medicare.

What the Bill Actually Does

The Patients First Act has three major provisions.

The PMPM pilot. A five-year demonstration program would pay participating primary care providers a per-member-per-month supplemental payment alongside their standard fee-for-service reimbursement. The pilot targets internal medicine physicians and subspecialists in independent or private practice. The hybrid model means doctors would still bill normally for services but receive an additional monthly payment per enrolled patient. No patient cost-sharing would apply to the PMPM component.

Inflation-indexed reimbursement. The bill would tie the Medicare physician fee schedule to a measure of medical inflation. Physician pay under Medicare has been effectively flat for two decades while practice costs have climbed. The American College of Physicians called this provision critical for “protecting Medicare beneficiaries’ access to care by bolstering the primary care workforce,” according to ACP President Dr. Jan K. Carney.

MIPS replacement. The bill introduces the Patient Outcome Improvement National Tabulation System (POINTS), which would replace the current MIPS framework. POINTS would shift quality metric development to physician-led processes at CMS and reduce administrative burden. The budget neutrality threshold would increase from $20 million to $54.3 million, giving CMS more room to invest without triggering automatic payment cuts elsewhere.

Why the PMPM Pilot Matters for DPC

The pilot is limited to independent and private practitioners, which means employed physicians in large health systems wouldn’t qualify. The Infectious Diseases Society of America flagged this as a significant limitation, noting it “greatly limits the number of ID physicians who could benefit.”

But for DPC, that limitation is the point. Independent practice is where DPC lives. And the payment structure Congress is proposing to test is the one DPC doctors already use every day.

There’s a meaningful difference, of course. DPC practices collect PMPM fees directly from patients or employers and don’t bill Medicare at all. This pilot layers a PMPM payment on top of fee-for-service Medicare billing. It’s a hybrid, not a full transition. But the signal is clear: Congress is looking at per-member-per-month payment as a tool for keeping independent primary care alive.

This bill also lands less than two weeks after the IRS issued guidance on DPC-HSA compatibility, which defined exactly how DPC memberships qualify as HSA-eligible expenses. The legislative and regulatory momentum around DPC-adjacent payment models is stacking up fast.

What This Means

The Patients First Act is a bill, not a law. It still has to survive committee markup, floor votes in both chambers, and a reconciliation process. Plenty of MACRA reform proposals have died in committee before.

But three things make this one different from past attempts. First, it’s bipartisan, co-sponsored by the chairs of both the Republican and Democratic Doctors Caucuses. Second, it’s physician-authored, written by three members of Congress who practiced medicine. Third, it’s arriving in a year when the HSA-DPC law, the MIPS payment cliff, and the primary care workforce shortage are all in the news at the same time.

If you’re running a DPC practice, this bill doesn’t change your business today. But it validates the payment model you already use. And if the pilot succeeds, it could shift how Medicare thinks about paying for primary care, moving away from per-visit billing and toward the kind of relationship-based payment that DPC was built on.

If you’re a resident or early-career physician weighing your options, watch this bill. The payment model Congress is now testing inside Medicare is the one DPC doctors chose voluntarily years ago.