Strengthening Medicare for Patients and Providers Act
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This bill would link annual Medicare physician payment updates to the Medicare Economic Index starting in 2026.
What it does
This bill would change how Medicare calculates payment rates for physician services starting in 2026. It proposes to replace the current system of separate payment updates for different types of providers with a single conversion factor for all physicians. Under this proposal, annual payment adjustments would be tied to the Medicare Economic Index, which tracks changes in the costs of providing medical services.
Who is affected
This bill affects physicians and healthcare providers who receive payments under the Medicare physician fee schedule, including those identified as qualifying participants in advanced alternative payment models. The legislation also impacts the administrative processes used to determine payment amounts for these providers by shifting to a single conversion factor based on the Medicare Economic Index. Additionally, Medicare patients may be indirectly affected by changes to how their healthcare providers are reimbursed for services.
Key provisions
- Consolidation of Medicare physician conversion factors. The bill eliminates the separate conversion factors currently used to calculate Medicare payments for qualifying alternative payment model participants and other physicians, replacing them with a single conversion factor starting in 2026.
- Adjustment of annual payment updates. Beginning in 2026, the bill replaces the fixed annual updates of 0.75% and 0.25% with a new update tied to the annual percentage increase in the Medicare Economic Index.
Fiscal impact
Not applicable: No CBO cost estimate available
Effective dates
The bill's provisions to replace separate conversion factors with a single update based on the Medicare Economic Index are scheduled to take effect beginning in 2026.
Relationship to existing law
The bill modifies existing payment adjustment protocols under the Medicare physician fee schedule by replacing separate conversion factors for different physician categories with a single update mechanism based on the Medicare Economic Index beginning in 2026.
Stated purpose
The bill aims to modify how Medicare physician fee schedule payments are calculated by replacing separate conversion factors for different types of providers with a single, unified conversion factor. It intends to tie annual payment updates to the Medicare Economic Index to ensure physician reimbursement reflects annual price changes.