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Costs & IRMAA

Bipartisan Senate Bill Would Cap Year-to-Year Medicare Physician Payment Swings

Six senators from both parties introduced legislation to limit how much the Medicare physician conversion factor can change in a single year, aiming to reduce the uncertainty that has pushed some doctors away from accepting Medicare.

By the Goodsurance editorial teamAugust 7, 2026

Six senators from both parties introduced S.5180, the Provider Reimbursement Stability Act, on July 30, 2026. The lead sponsors were John Boozman of Arkansas and Peter Welch of Vermont, joined by Roger Marshall of Kansas, Angus King of Maine, Thom Tillis of North Carolina, and Jeanne Shaheen of New Hampshire.

The bill targets a structural feature of Medicare's physician payment formula that has produced annual swings in the conversion factor, the base multiplier used to calculate what the program pays for every covered service. Current budget-neutrality rules require that when CMS adds new billing codes or increases payment for some services, corresponding reductions must offset the added cost. The threshold that triggers those offsets has not kept pace with rising practice costs. The bill would raise that threshold, index it to an inflation measure on a regular cycle, and cap the year-to-year change in the conversion factor at no more than 2.5 percent in either direction.

Six senators want to end annual Medicare physician payment whiplash by capping yearly swings at 2.5 percent.

Physician groups have argued that unpredictable annual adjustments make it harder to sustain Medicare-accepting practices, particularly in primary care and rural settings. Congress has repeatedly passed temporary patches to prevent the largest scheduled cuts rather than addressing the underlying formula.

A companion measure cleared the House Ways and Means Committee earlier in 2026. S.5180 was referred to the Senate Finance Committee, where its prospects for a floor vote before year-end remain uncertain.

In plain words

Medicare pays doctors using a formula. One part of that formula changes each year, sometimes dropping sharply when new services are added. Six senators from both parties introduced a bill to put a limit on those changes. The bill would cap how much the payment number can go up or down in a single year at 2.5 percent. It would also update a budget rule that has not kept up with rising costs. If the bill passes, doctors who accept Medicare could have more stable income, which may help patients keep their Medicare doctors.

Understand the basics first

Source: American Medical Association
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