ACC raises red flags over telehealth, payment reform and the cardiologist shortage

“The issue with telehealth right now is that it stopped when the government shut down,” Biga explained. “Whether or not you use telehealth is really up to your system, legal and your compliance teams until we get past the government shutdown.”

Many healthcare organizations had hoped Congress would make telehealth coverage permanent. Instead, providers are once again caught in a cycle of temporary extensions, delays and uncertainly.

"We need telehealth the way we had it for COVID. We don't want to go back to having it so restricted. I think the one thing we learned during COVID, especially in our rural areas, was how important telehealth is for our chronically ill cardiovascular patients. It really helps us prevent readmission," Biga explained.

New payment models raise questions for specialists

Biga said the ACC is also closely monitoring the next wave of federal payment reforms, including two key models—the Acute Care Episode model and the Ambulatory Specialty Model (ASM)—that will reshape reimbursements starting in 2026.

The ASM model, which includes heart failure care as one of its focus areas, will test new specialty-based payment systems with up to 9% financial risk placed on individual physicians treating more than 20 episodes of heart failure annually.

“This is a harbinger of things to come,” Biga said. “It changes how reimbursement will work, and the quality metrics built into these models are going to be very important.”

At the same time, proposed cuts to the 2026 Medicare Physician Fee Schedule are alarming cardiology practices. One of the bigger concerns this year is Medicare adding what it calls efficiency reductions as a reason to lower payments. The Centers for Medicare and Medicaid Services (CMS) said practices should be able to lower expenses by using new technology and becoming more efficient in procedures.

“We thought we might finally get a slight increase,” Biga said, “but instead, many of our interventional procedures are taking double-digit hits on practice expense and efficiency adjustments. It’s not sustainable.”

She said left atrial appendage occlusion (LAAO) procedures are getting a large 27% cut. Large cuts are also coming for cardiac ablations and percutaneous coronary interventions (PCI).

Discussions continue about replacing the Relative Value Unit (RVU) system that determines physician pay, she added, but there is no clear alternative.

“It’s imperfect, but it’s still physician-led—and we don’t want to lose that control," she said.

She thinks one main issue is that the physician fee schedule does not get increased funding each year for its budget.

"We can't keep taking these decreases. It's something that makes it difficult. Our expenses, just like the hospitals continues to escalate, our labor costs, our supply costs, our normal rent costs, all of those have not gone down post-COVID," she stressed.

Physician shortages deepen as Trump puts breaks on physician immigration

Another major issue on the ACC’s radar is the growing shortage of cardiologists, compounded by President Trump's new H-1B visa restrictions and Medicare's limited on the number of available medical residency slots.

“Cardiology is a global community,” Biga said. “The U.S. depends on international physicians to meet patient demand, but visa issues are making that harder. We already have a shortage, and it’s getting worse.”

The challenge is particularly acute in subspecialties such as amyloidosis, cardio-obstetrics and cardiometabolic care—fields that are expanding rapidly as patient complexity increases. As baby boomers age, they are accessing more and more services, and access to that care if now becoming a big issue.

“It’s not about longer life expectancy—it’s about healthier life expectancy,” she added. “Our population is aging, and demand for care is rising. Yet it’s harder than ever for patients to get appointments, sometimes waiting months. We need a strong, global pipeline of trained physicians to meet those needs.”