A bill built as a direct answer to the cut
The timing was deliberate. One day after CMS released the proposed 2027 Medicare Physician Fee Schedule — which trims the conversion factor by more than 1% — three physicians in Congress introduced the Patients First Act of 2026. The sponsors are Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA) — the respective chairs of the GOP and Democratic Doctors Caucuses. That a Democrat and two Republicans, all practicing physicians, put their names on the same bill is the headline: the fix is being framed as a bipartisan structural repair, not a one-year patch.
The mechanics of the 2027 cut itself — the exact conversion-factor dollar figures and why CMS still projects a net positive for radiology this year — are a separate story. This piece is about the legislative response: what the Patients First Act would change if it became law, and why it matters to independent groups regardless of whether it passes.
What the bill would actually do
Three provisions matter most for radiology economics:
An inflation-linked payment update
The bill would abandon the fixed year-to-year update formula set under the 2015 MACRA law and instead tie the fee-schedule update to inflation — specifically the Medicare Economic Index minus one percentage point. That replaces the flat, sub-inflation statutory bumps that have let physician pay fall behind rising practice costs.
A 2.5% cap on conversion-factor swings
Year-to-year changes in the conversion factor would be limited to 2.5% in either direction, "to avoid any substantial swings in reimbursement for physicians." Predictability, not just level, is the point — groups plan hiring and capital against the multiplier that sets revenue per study.
A higher budget-neutrality threshold
CMS would gain more room to adjust rates in rulemaking by raising the budget-neutrality trigger from $20 million to $54.3 million, with inflation adjustments every five years. A higher floor means fewer of the across-the-board conversion-factor cuts that get triggered when one code revaluation ripples through the whole schedule.
The bill also establishes a primary care hybrid payment pilot: independent physicians would receive a per-member-per-month capitated payment alongside part of their traditional fee-for-service reimbursement, with no patient cost sharing. The pilot is aimed squarely at physician-owned practices — the through-line of the whole bill.
The politics: reversing "decades of consolidation"
The sponsors describe the bill as bolstering incentives to save independent practices and "reversing decades of consolidation." That framing is the political spine of the legislation, and it is the part most relevant to radiology's ownership structure. When the fee schedule pays less and gets less predictable, small and mid-size groups are the ones that get squeezed into selling — to hospitals, to national teleradiology chains, or to private equity. A payment update that keeps pace with inflation and caps the downside is, functionally, an anti-consolidation lever: it makes staying independent financially survivable.
For radiology specifically, consolidation pressure is already acute — it is a recurring theme in whether groups can stay independent under private-equity roll-ups, and it interacts with the facility-side site-neutral payment cuts hitting hospital outpatient imaging. The Patients First Act attacks the professional-fee side of the same squeeze.
The imaging piece: the ROOT Act and appropriate use criteria
The most radiology-specific provision is the incorporation of the Radiology Outpatient Ordering Transmission (ROOT) Act, which the American College of Radiology publicly applauded. The ROOT Act would revive Medicare's imaging appropriate use criteria (AUC) program — the requirement that a referring clinician consult evidence-based clinical decision support before ordering advanced imaging. CMS shelved that program in 2023 after years of implementation delays; the ROOT Act amends the AUC section of the 2014 Protecting Access to Medicare Act to "reduce burdens and barriers" in the data-collection requirements and bring it back in a workable form.
ACR CEO Dana H. Smetherman, MD, framed it as "a practical path forward that can help improve access and ensure patients receive the most appropriate imaging exams while reducing unnecessary, low-value scans and associated costs." The ACR cites projected savings of roughly $2 billion to Medicare and $1.5 billion to beneficiaries over 10 years.
The AUC angle cuts a specific way for reading radiologists. AUC is a demand-side control aimed at ordering physicians — it targets the low-value scans that shouldn't be ordered in the first place, a problem we've covered under the overutilization of medical imaging. If it works, it dampens the growth of marginal studies. It does not, however, touch the cost of interpreting the studies that are ordered — and volume from an aging population keeps rising faster than AUC can trim it.
| Lever | What it targets | Who controls it / timing |
|---|---|---|
| Inflation-linked update + 2.5% cap | Revenue per study (professional fee) | Congress; uncertain, phases in over years |
| Anti-consolidation incentives | Independent-practice survival | Congress; uncertain |
| ROOT Act / imaging AUC | Volume of low-value ordered scans | Congress + ordering clinicians; uncertain |
| Cost per interpreted study | Reporting throughput / margin | The group itself; available now |
Why the cost side matters whether or not the bill passes
A bill is not a law. The Patients First Act has real bipartisan backing and endorsements from the ACR and the American College of Physicians, but its path through Congress is uncertain and its effects would phase in over years. Even in the best case, an inflation-linked update slows the erosion of revenue per study; it does not reverse it, and it does nothing about the interpretation cost sitting on the other side of the ledger.
That is the lever a group actually controls today. Margin on Medicare imaging is a function of how many studies each radiologist-hour turns into a signed, billable report. Adding radiologists raises cost in a supply-constrained market; raising throughput per radiologist does not. AI that drafts a structured, comprehensive report lets a radiologist review and sign more studies per hour instead of dictating each one from a blank screen.
That is how xAID is built to work for reading groups: the AI produces a structured CT report, xAID's in-house European radiologist reviews every preliminary, and it is delivered ready-to-sign so your reading radiologist signs the final. Legislation moves the revenue line slowly and unpredictably; reporting throughput is the margin lever an independent group can pull now.
Frequently asked questions
What is the Patients First Act?
The Patients First Act of 2026 is a bipartisan House bill introduced by physician-lawmakers Reps. John Joyce, MD (R-PA), Greg Murphy, MD (R-NC), and Kim Schrier, MD (D-WA), the chairs of the GOP and Democratic Doctors Caucuses. It would replace the current MACRA-era update formula with a payment update tied to inflation, cap year-to-year conversion-factor swings, raise the budget-neutrality threshold, create a primary care hybrid payment pilot for independent practices, and revive Medicare's imaging appropriate use criteria (AUC) program through the incorporated ROOT Act. It was introduced the day after CMS released the 2027 Medicare fee schedule.
How would the Patients First Act change Medicare physician pay?
The bill would tie the Medicare physician fee schedule update to inflation — specifically the Medicare Economic Index minus one percentage point — instead of the current fixed statutory updates. It would also limit year-to-year changes in the conversion factor to 2.5% to avoid large swings, and raise the budget-neutrality threshold from $20 million to $54.3 million (adjusted for inflation every five years), giving CMS more room to make rate adjustments without triggering across-the-board cuts.
What is the ROOT Act and how does it affect imaging?
The Radiology Outpatient Ordering Transmission (ROOT) Act, incorporated into the Patients First Act, would modernize and revive Medicare’s imaging appropriate use criteria (AUC) program, which CMS shelved in 2023. It amends the AUC section of the Protecting Access to Medicare Act of 2014 to reduce data-collection burdens, and would have ordering clinicians consult evidence-based clinical decision support before ordering advanced imaging. The American College of Radiology, which supports the provision, cites projected savings of roughly $2 billion for Medicare and $1.5 billion for beneficiaries over 10 years.
Does an independent radiology group need this bill to pass to protect its margin?
No. The bill, if enacted, would slow the erosion of the conversion factor and reward independent practices, but its outcome is uncertain and its effects would phase in over years. The revenue attached to each study still trends down over time regardless. The lever a group controls now is cost per study — how many studies each radiologist-hour turns into a signed, billable report. AI that drafts a structured, comprehensive report lets a radiologist review and sign more studies per hour instead of dictating each from scratch, which improves margin whether or not the legislation passes.
Source: Radiology Business coverage of the Patients First Act of 2026, "Physician lawmakers introduce bipartisan fix for radiologist Medicare pay woes"; the sponsors' joint announcement; and ACR commentary on the ROOT Act via ITN Online. Figures are as reported.