US senator introduces bill that would slash $2B in imaging spending
A U.S. senator has introduced legislation that would slash $2 billion in imaging spending while also bolstering radiologist pay.
Sen. Roger Marshall, MD, R-Kan., recently proposed the Patients First Act of 2026 in the upper chamber. A companion bill to a version introduced in the U.S. House in July, the legislation would tie physician reimbursement in the Medicare program to a measure of inflation.
The proposal also incorporates language from the Radiology Outpatient Ordering Transmission (ROOT) Act—which would revive the stalled imaging appropriate-use criteria program. If approved, it would require referring physicians to consult clinical decision support before ordering scans, hoping to root out unnecessary and wasteful imaging.
The American College of Radiology—which supports the bill—estimates that the ROOT Act would reduce federal spending on medical imaging by about $2 billion over the next decade. In addition, it would save Medicare beneficiaries another $1.5 billion during the same timeframe.
“The ROOT Act provisions would modernize implementation of Medicare’s Appropriate Use Criteria program for advanced diagnostic imaging,” ACR said in a news update touting its support for the bill on Oct. 15. “The Patients First Act also includes broader Medicare physician payment reforms, including annual payment updates tied to the Medicare Economic Index, changes to Medicare budget-neutrality policies and reforms to quality reporting requirements.”
S. 5672 was first introduced in the U.S. Senate on Sept. 30 and currently does not have any co-sponsors, according to Congress.gov. Sen. Marshall—a former OB-GYN specialist who is up for reelection in November—had not released an official statement about the bill as of Thursday. S. 5672 has now been referred to the Senate Finance Committee for further consideration.
Reps. Kim Schrier, MD, D-Wash., John Joyce, MD, R-Pa., and Greg Murphy, MD, R-N.C., are sponsoring the House version of the bill. They contend the proposal would help to save independent practices and “reverse decades of consolidation.” In other provisions, the legislation would establish a new primary care hybrid payment pilot program that would grant PCPs per-member, per-month reimbursement, “better capturing” their productivity. The Patients First Act also would create a physician-led task force at CMS to develop quality metrics that are “streamlined and reduce administrative burden” Plus, it would increase the budget neutrality threshold from $20 million to $54.3 million, among other changes.
Lawmakers note that 70% of medical practices nationwide are now owned by hospitals or other corporations. About 1 in every 10 physicians works for UnitedHealth or an affiliate. Running an independent doc group is becoming increasingly difficult, forcing practices to close due to low Medicare reimbursement rates, they contend.
“Our current Medicare physician payment system is unsustainable,” Rep. Murphy, a practicing urologist, said in July. “It has fueled consolidation, increased administrative burdens, and made it harder for independent physicians in rural communities to continue serving the patients who rely on them. The bipartisan Patients First Act delivers long-overdue reforms that strengthen independent practices, invest in primary care, and ensure physicians can spend more time caring for patients instead of navigating bureaucracy.”
Other medical trade groups, such as the American Society of Nuclear Cardiology, also have expressed opposition to reviving the imaging appropriate-use criteria program.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.