Cardiologist says new legislation would delay flawed payment cuts, preserve access to care
Cardiovascular societies are urging lawmakers to back bipartisan legislation aimed at delaying a new Medicare payment cut they say would further erode already strained physician reimbursement rates and threaten patient access to care.
H.R. 7520 would delay implementation of the 2.5% “efficiency adjustment” reduction included in the 2026 Medicare Physician Fee Schedule (MPFS) until 2030. The provision assumes physicians become more efficient over time—including through the adoption of advanced technologies such as artificial intelligence—and therefore require lower reimbursement. The current Medicare policy regarding the efficiency adjustments also leave the door open to further reductions in the coming years.
The bill has drawn support from leading cardiovascular organizations, including the American College of Cardiology (ACC), American Society of Echocardiography (ASE), American Society of Nuclear Cardiology (ASNC), Society for Cardiovascular Magnetic Resonance (SCMR), Society for Vascular Surgery (SVS), Heart Rhythm Society (HRS), and Society of Thoracic Surgeons (STS), which recently signed a joint letter backing the legislation.
Friederike Keating, MD, director of nuclear cardiology at University of Vermont Health and chair of the ASNC Health Policy Committee, told Cardiovascular Business this adjustment stems from a decades-old framework tied to the Medicare Economic Index.
“There's an interesting history to the efficiency adjustment. I think it's many decades old,” Keating said.
The adjustment, she explained, was developed alongside an inflationary component intended to account for rising practice costs.
“On one side, the Medicare economic index was meant to kind of adjust in simple terms for inflation. And on the other side it was also supposed to adjust for things like increased efficiency.”
However, she noted that while hospitals have received inflationary updates over the years, physicians largely have not.
“So it's basically a negative adjustment for purported more efficient practices, but still we're kind of missing the other side of that coin, the inflationary adjustment. So that doesn't seem to make a lot of sense to us,” Keating explained.
Under Medicare's budget neutrality rule it cannot increase overall physician spending beyond a fixed amount. This means new services or payment changes often result in cuts elsewhere. Keating described it as a “zero sum game,” where “the pie stays the same, but the slices of the pie, as healthcare increases in what it delivers, get smaller and smaller.”
She said this legislation would pause the efficiency adjustment and establish guardrails to prevent repeated automatic cuts without clear justification.
“The bill is supposed to put a halt on it and then allow for some refashioning with guardrails,” she said, adding that the legislation would prevent successive 2.5% reductions and require CMS to better justify any efficiency-based changes.
Keating emphasized that physicians have already experienced significant erosion in inflation-adjusted reimbursement. The American Medical Association said the combined cuts to physicians and the lack of an inflationary increase means that since 2001, physicians have seen more than a 33% decrease in Medicare payments.
“If you look back over the last 10 years and you're looking at how much of an inflationary adjustment actually has happened to physician reimbursement, it's been like 3%” she said. “Physicians have experienced a real cut in reimbursement, and now on top of that they're getting that taken away by saying, 'oh, well, we're going to just adjust for efficiency.'”
Cardiology leaders argue that this continued payment pressure has cause private cardiology practices to go out of business, or forced them to join larger health systems. Keating said this has the opposite effect Medicare wants in reducing prices because it is reducing competition and potentially increasing overall healthcare costs. She said it is usually more cost effective to see patients in an outpatient office setting, but reimbursement policy is driving people to hospital systems.
While Keating said there is a real need for Congress to make major reforms with Medicare and how physicians are paid, the immediate goal is preserving access to care, which H.R. 7520 would accomplish.
“The goal is preserving access to patients, access to doctors, access to technology,” she said. “The legislation is supposed to help keep us viable at least, and keep us in a position that we can provide services to our patients. I think that's the bottom line.”
ASNC is asking its members to contact their Congressmen to support this bill and sign on as cosponsors. Read more of this legislative push.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]