This legislation, known as the Patients First Act of 2026, aims to significantly modify physician payments under the Medicare program, focusing on strengthening reimbursement, enhancing patient access, and reforming quality reporting systems. It begins by adjusting the Medicare physician conversion factor updates for 2027 and subsequent years, introducing floors and ceilings for non-qualifying Advanced Payment Model (APM) conversion factors to stabilize physician reimbursement. The bill also mandates annual reports to Congress on the impact of these updates on beneficiary access and physician practice consolidation. A key provision establishes a hybrid payment model for primary care services , effective from 2027 through 2031. Under this model, qualifying primary care suppliers will receive monthly payments for attributed individuals, replacing traditional fee-for-service payments for designated primary care services. The model includes an attribution process allowing beneficiaries to designate a primary care provider or be attributed based on claims history, and it defines specific primary care services and criteria for qualifying suppliers, notably excluding certain practices not majority-owned or controlled by physicians or designated health care practitioners. The bill also introduces a work geographic floor adjustment for high inflationary years, increasing the work geographic index for payments from 2027 to 2033 if the consumer price index rises by more than 2 percent. Furthermore, it mandates a Comptroller General study on economic factors influencing physician practice location choices, including salaries, costs, and service volumes. A major reform renames the Merit-based Incentive Payment System (MIPS) to the Patient Outcome Improvement National Tabulation System (POINTS) , effective January 1, 2032. This new system introduces a 'care efficiency' performance category for 2032 and beyond, replacing the clinical practice and meaningful use categories. The weights for performance categories will shift, with Quality becoming 65% and Cost 20%, while Promoting Interoperability and Improvement Activities will have 0% weight for 2032 and subsequent years. To guide these changes, the bill establishes a Quality Reform Task Force , composed of representatives from the Department of Health and Human Services, professional organizations, and other experts. This Task Force will issue recommendations for quality, resource use, and care efficiency measures, ensuring they align with clinical guidelines and promote quality of care. The Secretary of Health and Human Services must formally respond to these recommendations, with specific requirements for including or excluding recommended measures. MIPS payment adjustments are modified, with the maximum positive adjustment set at 2% for 2027-2031, gradually increasing to 5% by 2034. The bill also protects MIPS eligible professionals from payment reductions if the Secretary fails to provide timely feedback on administrative claims-based measures. However, positive adjustments for professionals in 'excluded practices' will be reduced by 50% starting in 2032. The legislation modifies requirements for Qualified Clinical Data Registries (QCDRs) , mandating that they be established and operated by professional societies led by designated practitioners, demonstrate data quality, and provide timely feedback. QCDR approvals will now be effective for three-year periods. Additionally, the bill expands access to Medicare claims data for QCDRs and clinician-led registries for research and quality improvement purposes, allowing them to link claims data with clinical outcomes data. Changes to Appropriate Use Criteria (AUC) for imaging services shift reporting responsibilities to qualified clinical decision support mechanisms starting in 2027. It introduces exemptions for small and rural practices, as well as for specific services like mammography and lung cancer screenings. The bill also redefines 'outlier' ordering professionals as 'low compliant' and requires studies on compliance rates and the impact of AUC on imaging utilization. Finally, it updates the budget neutrality threshold for Medicare physician fee schedule adjustments, increasing it to $57.64 million for 2028 and indexing it for subsequent years, and requires timely, simultaneous updates to direct cost inputs for practice expense relative value units at least every five years. It also limits year-to-year conversion factor variance to 2.5% while maintaining budget neutrality.