August 28, 2026
The Honorable David Kustoff
U.S. House of Representatives
560 Cannon House Office Building
Washington, DC 20515
RE: Please cosponsor H.R. 9693, the Patients First Act
Dear Congressman Kustoff:
On behalf of the Memphis Medical Society Board of Directors and the physicians we represent
throughout Memphis and West Tennessee, I write to urge you to cosponsor H.R. 9693, the
Patients First Act. This bipartisan legislation offers a meaningful opportunity to replace the
recurring cycle of Medicare physician payment cuts and temporary congressional fixes with a more
stable and predictable payment system.
At its core, the request physicians are making is remarkably modest: for a typical Medicare office
visit, we are essentially asking Medicare to pay about $3 more.
That small increase matters because Medicare physician reimbursement has failed to keep pace with
the cost of providing care. Adjusted for inflation in practice costs, Medicare physician payment has
fallen approximately 33 percent since 2001, while physician practices have faced steadily rising
expenses for personnel, technology, supplies, insurance, and regulatory compliance. Physicians
remain the only major Medicare provider category without a permanent annual payment update tied
to inflation.
Tennessee illustrates the problem. Medicare treats our entire state as one physician-payment locality.
Tennessee’s 2026 Medicare geographic adjustments include a practice-expense GPCI of 0.909 and a
malpractice GPCI of 0.537, both below the national benchmark of 1.000. For a common
established-patient office visit (CPT 99214), the current Tennessee Medicare PFS amount is about
$127.36 before sequestration.
The American Medical Association’s 2027 modeling of the Patients First Act makes the size of the
request easy to understand. In representative localities, the same 30-39 minute office visit increases
by about $3 – from $133 to $136 in Montana, $129 to $132 in the rest of Texas, and $128 to $131 in
the rest of New York. The precise Tennessee 2027 amount will depend on final CMS rulemaking
and implementation, but the scale of the policy is clear: roughly three additional dollars for a
typical office visit.
The Patients First Act would also establish a permanent annual Medicare physician payment update
linked to the Medicare Economic Index, extend and strengthen the work Geographic Practice Cost
Index floor, modernize outdated budget-neutrality policies, simplify quality reporting, and expand
opportunities for physicians to participate in alternative payment models.
Over the longer term, the distinction is significant. The AMA estimates that under current law,
cumulative Medicare physician payment updates for most physicians from 2026 through 2036 would
be essentially flat – just 0.03 percent. Under the Patients First Act, cumulative updates would instead
grow by approximately 7.7 percent.
For Memphis and West Tennessee, this is ultimately about patient access. Independent and
community-based practices are essential to our health care infrastructure. When reimbursement fails
to keep pace with the cost of employing staff, maintaining offices, purchasing technology, carrying
insurance, and meeting regulatory requirements, physicians face increasing pressure to consolidate,
reduce services, or limit their participation in Medicare.
We respectfully ask you to cosponsor H.R. 9693 and support advancement of the Patients First
Act. We would welcome the opportunity to discuss Medicare physician reimbursement and its
impact on physicians and Medicare beneficiaries in the 8th Congressional District and throughout
West Tennessee.
Thank you for your consideration and for your service to West Tennessee.
Sincerely,
Clint Cummins, MHA
Chief Executive Office
Catherine Womack, M.D. President
James Beaty, M.D. Immediate Past President
David Cannon, M.D. President-Elect
Perisco Wofford, M.D. Vice President
Melanie Woodall, M.D. Secretary
Emily Coursey, M.D. Treasurer
