CMS finalizes more payment cuts with 2027 Medicare PFS—new policy targeting cardiologists still in place
The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized the 2027 Medicare Physician Fee Schedule (PFS), which includes payment cuts for physicians and a new mandatory policy targeting thousands of cardiologists.
Under the new Medicare PFS, the conversion factors have decreased by 1.83% for practitioners participating in a qualified alternative payment model (APM) and 2.31% for those not participating in an APM. Both conversion factors have decreased slightly more than CMS originally proposed back in July. In addition, it’s worth noting that the one-time 2.5% conversion factor increase that was part of the One Big Beautiful Bill Act has officially expired.
Another key takeaway from the final Medicare PFS is that CMS kept the new Ambulatory Specialty Model (ASM) focused on reducing healthcare costs associated with heart failure. This is a mandatory program scheduled to run for five years, from Jan. 1, 2027, to Dec. 31, 2031. The effect of this new payment model will be different for each of the approximately 2,600 cardiologists now required to participate. CMS has said some specialists will see their Medicare Part B payments decrease by as much as 9%. On the other hand, it is technically possible for a specialist to see their payments increase by as much as 9%. After the program’s first two years, these adjustments will be scaled so that a physician’s payments could either decrease or increase even more—by up to 12%.
The American College of Cardiology (ACC) and other medical societies have repeatedly shared their concerns about the ASM for heart failure. The ACC even identified hundreds of cardiologists who were told they had to participate even though they don’t meet the predetermined requirements.
In addition, a recent report out of the Center for Healthcare Quality and Payment Reform argued that the ASM is a “remarkably bad program” that will negatively impact access to care over the next few years.
Despite those objections, however, the ASM for heart failure is set to officially begin on Jan. 1.
Click here for additional details from CMS about the 2027 Medicare PFS final rule.
American College of Cardiology ‘deeply disappointed’ by final rule
The ACC was quick to share its thoughts about the finalized policy.
“The ACC is deeply disappointed that CMS finalized several policies that will make it harder for cardiovascular clinicians to deliver the care their patients need,” ACC President Roxana Mehran, MD, said in the group’s statement. “At a time when cardiology practices continue to face significant cost pressures, inadequate recognition of inflationary pressures, implementation of the ASM without additional testing, reductions in payment for key cardiovascular services, and restrictions on remote physiologic monitoring risk reducing access to essential cardiovascular services and adding further strain to the health care system. The ACC will continue to work with Congress and CMS on solutions that protect patients, support clinicians and strengthen the long-term stability of cardiovascular care.”
The Society of Thoracic Surgeons (STS) has also been working to help its members understand the new Medicare PFS final rule. Click here for its updated perspective on these policies.
“STS will continue to dig further to see if CMS has accepted our recommendations on specific codes impacting general thoracic surgeons,” the organization wrote.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.