ACC president details key advocacy efforts in cardiology
American College of Cardiology (ACC) President Cathie Biga, MSN, has outlined the organization’s top advocacy priorities, which include Medicare payment reform, site neutrality in payments and improved patient access to peripheral artery disease (PAD) screenings.
During the American Heart Association (AHA) 2024 conference, Biga spoke with Cardiovascular Business about the ongoing challenges facing cardiologists, particularly the repeated Medicare cuts impacting patient care.
"Probably the most important issue to all of our physicians is the ongoing continuous Medicare cuts that we have with our physician fee schedule. And it's something that we take to Congress year after year. We used to kick the can down the road, and it hasn't changed. We are really trying to work on a sustainability act that either increases the fee schedule, much like our colleagues with the inpatient fee schedule and hospital outpatient fee schedule, who always gets a raise. The physician fee schedule is a zero sum game," Biga explained.
The 2025 Medicare Physician Fee Schedule reduced cardiologist payments by 2.83%. This pay cut is just part of a nearly annual series off payments since 2001, with the American Medical Association (AMA) says totals a 33% cut to physician payments over the past 24 years. This is compounded with the Centers for Medicare and Medicaid Services (CMS) estimates for 2025, which project a 3.6% increase in practice cost expenses due to inflation. Physicians do not get inflationary increases like hospitals and health systems do, which has been a major issue physicians groups have argued for in Congress for years.
While efforts to get action on this failed in the lame duck session on Congress in December, a bill reintroduced in the new Congress Jan. 31 calls for not only eliminating the 2.83% cut, but also giving physicians a boost in pay for inflation for the remainder of 2025.
"It's really about a permanent fix, whether we tie it to the Medicare Economic Index (MEI), or whether we just increase the dollar amount that's available every year. Something that is permanent is critical," Biga said. "When I talk to our physicians, I call it death by a thousand cuts. If you really take our fee schedule back to 2019 you see each year it's a dollar here, $2 here, 50 cents here, so you think maybe it's not so bad, but then you add it up and it's a large cut. And our expenses, like everyone else, continues to increase ... we need to fix this."
Site neutrality could cut healthcare costs
A key part of ACC's advocacy efforts is pushing for site-neutral payments. The legislation seeks to address discrepancies in reimbursement rates between hospital outpatient departments and independent outpatient labs. Biga recognizes the financial challenges hospitals face, while also advocating for cost-effective care models. This is not a new issue, and has been a point of contention since at least 2015 as the number of outpatient office-based labs (OBL) and ambulatory surgical centers (ASC) increased, offering the same same-day procedures as hospitals at lower prices. Many simple procedures that can be done in hospitals also can be done in offices-based setting now.
Biggs said reimbursement for an office clinic visit is about $50, but the same visit on a hospital campus is about $150. While the American Hospital Association feels site neutrality would be unfair because of the additional overhead costs for running a large hospital, she said something needs to be done to contain healthcare costs, and addressing large discrepancies in payments for the same service seems like a good place to start.
ACC has developed seven principles that relate to site neutrality, and the most important is that any changes to Medicare payments should prioritize patient access, quality and value of care. ACC also stresses that any approaches to remove unnecessary or unexpected cost to patients and the healthcare system, including equity across outpatient ambulatory settings, should be discussed. These also need to be phased in over time to safeguard the stability of the healthcare system.
"What's really important is we have to keep our patients in mind. We have to make sure that anything we do doesn't further reduce access to care," Biga said.
Funding needed for PAD screenings to reduce high amputation rates
Another major legislative focus in 2025 is the effort to expand screenings for PAD in rural and low-income areas. ACC is backing a bill that aims to increase early detection of PAD, a condition that disproportionately affects minority populations and those in healthcare deserts.
In 2024, several cardiology and vascular groups created the PAD Pulse Alliance to raise awareness about PAD and it leading to its worst form of critical limb ischemia (CLI), which may require amputations of the toes, feet and legs if left un treated. Tracking CMS data for amputations, they are clustered around low-income, minority urban and rural areas where access to preventive care is often lacking.
"PAD is something that is really underdiagnosed, especially in our minority populations or in our hard-to-reach areas," she said.
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: dfornell@innovatehealthcare.com