Patients First Act Will Help Preserve Access to Office-Based Endovascular and Interventional Care
The Outpatient Endovascular and Interventional Society (OEIS) strongly supports the introduction of H.R. 9693, the bipartisan Patients First Act, introduced by Reps. John Joyce, M.D. (PA-13), Greg Murphy, M.D. (NC-03), and Kim Schrier, M.D. (WA-08). The legislation represents an important step toward strengthening Medicare physician payment and preserving patient access to office-based procedural services, including endovascular and interventional care.
Patients rely on timely access to highly specialized physicians who provide safe, high-quality care in the outpatient setting. Years of inadequate Medicare payment updates have placed increasing financial strain on physician practices, making it more difficult to sustain these essential services and threatening patients’ ability to receive care in convenient, lower-cost settings.
Title I of the Patients First Act would replace the existing Medicare Physician Fee Schedule (PFS) growth rate with an inflationary update based on the Medicare Economic Index (MEI), equivalent to MEI minus one percentage point. This provision would help stabilize office-based care by providing a more predictable payment update that better reflects changes in the cost of delivering care.
Preserving independent outpatient physician practices is particularly important for patients who require ongoing access to specialized endovascular and interventional services. As physician consolidation accelerates, patients can face fewer choices, longer wait times, and greater barriers to receiving care close to home—particularly in rural and underserved communities.
By helping stabilize outpatient physician practices, the Patients First Act supports continued access to high-quality, patient-centered endovascular and interventional care.
Other provisions of the Patients First Act would address ongoing concerns with the Medicare Physician Fee Schedule, including quality metrics, value-based programs, and budget neutrality. Title II would transition the Merit-based Incentive Payment System (MIPS) over a five-year period into a Patient Outcome Improvement National Tabulation System (POINTS), while Title III would update and improve the Alternative Payment Model program.
Title IV would reform underlying PFS budget-neutrality provisions by requiring retroactive adjustments to the conversion factor based on actual utilization relative to estimates, requiring the Secretary to update PFS direct-cost calculations every five years, and limiting year-to-year variation in the conversion factor outside other existing provisions of law to 2.5 percent.
The Patients First Act represents an important first step toward restoring predictability to Medicare physician payment by replacing recurring short-term fixes to the PFS conversion factor with an inflation-based update. However, this reform addresses only one dimension of a broader structural challenge within the Medicare Physician Fee Schedule.
Today, the PFS is expected to finance both physician professional services across sites of care and the advanced technical infrastructure necessary to deliver modern procedural care in the office setting. As increasingly sophisticated endovascular and interventional procedures have migrated safely from hospitals to outpatient physician practices, the PFS has struggled to adequately account for the equipment, supplies, clinical staff, and other practice expenses required to provide this care.
While an inflation-based update to the Physician Fee Schedule will help stabilize reimbursement for physician work, it will not resolve these longstanding structural challenges associated with financing advanced office-based procedural care. OEIS believes that broader PFS reform should recognize the distinct costs associated with providing complex endovascular and interventional services in the outpatient setting and establish a sustainable methodology for reimbursing those costs.
Medicare already maintains mature reimbursement methodologies for ambulatory practice expense through the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center payment system. These systems rely on data that are routinely collected and updated to reflect the costs associated with delivering procedural care.
Rather than continuing to rely solely on the Physician Fee Schedule to reimburse the significant practice expenses associated with advanced office-based procedures, policymakers should consider a payment structure that appropriately recognizes the resources required to deliver these services while preserving the efficiencies and patient benefits of the office-based setting.
Taken together, OEIS believes the Patients First Act would significantly improve the stability of physician practices and help preserve patient access to high-quality outpatient endovascular and interventional services. OEIS appreciates the bipartisan leadership of Representatives Joyce, Murphy, and Schrier and urges Congress to move quickly to enact this important legislation.
