Doctors cheer payment bill as Senate keeps AI prior auths in Medicare

Federal lawmakers took action this week on three fronts affecting how physicians are paid and how patients access care under Medicare. Two policy proposals drew praise from physician groups, though Democratic lawmakers continue to press against additional prior authorizations under the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model.

Patients First Act would update physician pay

The American College of Physicians (ACP) and two accountable care advocacy organizations applauded the Patients First Act introduced by Reps. John Joyce, M.D. (R-Pennsylvania), Greg Murphy, M.D. (R-North Carolina), and Kim Schrier, M.D. (D-Washington).

The bipartisan bill would provide an inflationary payment update for physicians and other clinicians under the Medicare Physician Fee Schedule, preserve higher payments for clinicians participating in risk-bearing alternative payment models, and freeze qualifying participant thresholds for those models for three years. After that period, the bill would give the secretary of the U.S. Department of Health and Human Services authority to set the threshold. The legislation also would raise the threshold that triggers budget neutrality adjustments and calls for a demonstration project testing hybrid payments for primary care that would not include patient cost-sharing.

ACP praised the bill because the legislation's investment in primary care, including the proposed hybrid payment demonstration, would help independent, physician-owned practices and address a worsening shortage of primary care physicians. In a statement, ACP President Jan K. Carney, M.D., said the inflationary fee schedule update and the higher budget-neutrality threshold would provide long-needed stability for physician payment.

The National Association of Accountable Care Organizations (NAACOS) also welcomed the bill. Clinicians "cannot take a pay cut" and that their compensation must reflect the ongoing cost of providing care, NAACOS President Emily Brower said in a statement. Alternative payment models have reduced health care costs by more than $37 billion over 12 years, saving Medicare $14 billion, while improving quality, Brower said. She added Congress should retain incentives for physicians to join the value-based models, since financial incentives to participate will otherwise be weaker than staying in traditional fee-for-service Medicare for several more years.

Mara McDermott, chief executive officer of Accountable for Health, an advocacy group representing more than 60 providers, payers and other health care organizations, said the bill builds on the 2015 Medicare Access and CHIP Reauthorization Act by preserving stronger payments for physicians in advanced alternative payment models. It also takes steps to overhaul the Merit-based Incentive Payment System, the program that adjusts Medicare pay based on quality and cost measures. McDermott said her organization looks forward to working with the bill's sponsors to expand physician participation in accountable, value-based care.

Prior authorization overhaul clears House committee

The House Ways and Means Committee on July 15 passed the Improving Seniors' Timely Access to Care Act, H.R. 3514, by a unanimous 42-0 vote during a full committee markup. The bill previously passed the House Energy and Commerce Committee's health subcommittee by voice vote on June 25. Ways and Means was the first of the bill's two House committees of jurisdiction to approve it at the full committee level.

The legislation, which has 297 House co-sponsors and 71 Senate co-sponsors, would modernize the prior authorization process in Medicare Advantage plans, the privately administered Medicare plans used by more than 35 million beneficiaries. The bill would increase government oversight and transparency of prior authorization decisions and establish an electronic prior authorization process.

House sponsors include Joyce and Reps. Mike Kelly (R-Pennsylvania); Suzan DelBene (D-Washinton); and Ami Bera, M.D. (D-California). Senate sponsors include Roger Marshall, M.D. (R-Kansas), and Mark Warner (D-Virginia).

The Regulatory Relief Coalition, a group of 16 national physician organizations, called the bill the most widely supported bipartisan, zero-cost health care legislation in the current Congress. The coalition noted that the Congressional Budget Office determined in the 118th Congress that the bill would have no impact on federal spending. The coalition said the bill is endorsed by more than 300 national and state organizations representing patients, physicians, medical technology and biopharmaceutical manufacturers, and insurers. While some insurers have voluntarily pledged to reduce prior authorization requirements, the coalition said, providers and patients have seen little meaningful change, underscoring the need for the legislation.

The American Medical Association (AMA) also praised the committee's action. The overwhelming bipartisan approval of the bill sends a message that more must be done to rein in health plans' prior authorization delays, AMA President Willie Underwood III, M.D., said in a statement. The legislation would streamline and standardize prior authorization requirements in Medicare Advantage and require health plans to report their denial rates to the federal government, reducing administrative burdens on physicians while helping ensure seniors get needed care in a timely way, he said.

"Today's unanimous vote reflects growing recognition that prior authorization, when misused, too often stands between patients and their physicians," Underwood said, adding that the AMA will continue working with Congress to get the bill enacted.

Senate rejects effort to overturn Medicare AI review model

The Senate voted 46-50 on July 16 to reject a motion to proceed to a joint resolution that would have repealed the Wasteful and Inappropriate Service Reduction (WISeR) Model, according to a Senate roll call vote summary. The vote fell short of the simple majority needed to advance the measure. Four senators did not vote.

The Centers for Medicare & Medicaid Services (CMS), led by Administrator Mehmet Oz, M.D., MBA, launched the WISeR Model in January 2026 as a pilot program using artificial intelligence and machine learning to review the appropriateness of certain services under traditional Medicare in a six-year trial in six states: Ohio, New Jersey, Oklahoma, Texas, Arizona and Washington.

Senate Democrats had opposed the model since before its launch. In September 2025, Sens. Ron Wyden (D-Oregon), Kirsten Gillibrand (D-New York), and Richard Blumenthal (D-Connecticut), called on the administration to halt the experiment. In December, Sens. Patty Murray (D-Washington), Wyden and Gillibrand introduced legislation that would have prohibited CMS from implementing WISeR. In April, Sen. Maria Cantwell (D-Washington), released a report describing the effect of care delays and denials on seniors under the model.

On May 20, Wyden, the Senate Finance Committee's ranking member, led Murray, Cantwell, Blumenthal, Gillibrand and 20 other Senate Democrats in introducing the Congressional Review Act resolution to repeal WISeR. "The last thing seniors need is even more AI denying the care they need," Wyden said at the time. A House companion resolution was introduced the same day by Reps. Greg Landsman, D-Ohio, and Suzan DelBene, D-Wash.

The push gained momentum this month when the nonpartisan Government Accountability Office determined, at Senate Democrats' request, that the WISeR Model is subject to the Congressional Review Act, meaning the administration should have submitted it to Congress before implementation. That determination opened a limited window for Congress to force a vote on repealing the model, setting up the July 16 Senate vote.

Sen. Jon Ossoff (D-Georgia), who co-sponsored the resolution, said in a July 14 statement that "the abuse of prior authorization practices has led to Georgians being denied life-saving medication and waiting months for the care they need." Ossoff has made prior authorization a recurring target this year, including a June amendment aimed at insurance-related care denials that Senate Republicans blocked and an April inquiry he opened with Oz on the same issue.