The Dialysis Vascular Access Coalition (DVAC) strongly supports the introduction of H.R. 9693, the bipartisan Patients First Act by Reps. John Joyce, M.D. (PA-13), Greg Murphy, M.D. (NC-03), and Kim Schrier, M.D. (WA-08). The legislation represents an important step toward strengthening Medicare physician payment and preserving patient access to specialized vascular access services.

Patients receiving dialysis rely on timely access to highly specialized physicians who provide lifesaving vascular access care. Years of inadequate Medicare payment updates have placed increasing financial strain on outpatient physician practices, making it more difficult to sustain these essential services. Title 1 of the Patients First Act would replace the existing Medicare Physician Fee Schedule (PFS) growth rate with an inflationary update based on Medicare Economic Index (MEI) at an equivalent of MEI -1%. This provision would help to stabilize outpatient dialysis vascular access in a way that better reflects the cost of delivering care.

Preserving outpatient physician practices is particularly important for patients with kidney disease, who often require ongoing, coordinated access to specialized outpatient services. As physician consolidation accelerates, patients face fewer choices, longer wait times, and greater barriers to receiving care close to home—especially in rural and underserved communities. By helping to stabilize outpatient physician practices, the Patients First Act supports continued access to high-quality, patient-centered vascular access care.

Other provisions of the Patient First Act would address ongoing concerns with other PFS-related issues, including quality metrics, value-based programs, and underlying budget neutrality provisions. Title II of the bill would transition the MIPS (Merit-based Incentive Payment System) program over a five-year period into a Patient Outcome Improvement National Tabulation System (POINTS). Title III would update and improve the Alternative Payment Model program. Title IV would reform underlying budget neutrality provisions in the PFS by 1) requiring retroactive adjustments in the conversion factor based on utilization estimates to reconcile differences, 2) requiring once every 5 years the Secretary update PFS direct cost calculations and 3) and limiting year to year variance of the conversion factor outside of other existing provisions of law to 2.5%.

Taken together, these provisions would significantly improve patient access to critical dialysis vascular access services. DVAC appreciates the bipartisan leadership behind this legislation and urges Congress to move quickly to enact this legislation. For more information, visit www.dialysisvascularaccess.org.