EP advocacy group details 6 key policy issues
Heart Rhythm Advocates (HRA), the advocacy arm of the Heart Rhythm Society (HRS), has shared a list of six legislative, regulatory and reimbursement policy actions it is watching that could impact electrophysiology (EP) in 2026 and beyond.
1. Medicare payment reform
To HRA, the single biggest issue to watch right now Medicare payment reform. The group explained it and other cardiology advocacy organizations are working with the Centers for Medicare and Medicaid Services (CMS) and Congress to make sure payment policies reflect the complexity of modern cardiovascular care.
While the 2026 Medicare Physician Fee Schedule (MPFS) did provide a small conversion factor increase, it also introduced a controversial new "efficiency adjustment." This was a –2.5% pay reduction for physicians that policymakers put in place because they assumed new technologies like artificial intelligence would increase efficiency and help more things get done in less time.
HRS said many physician groups believe this new reduction undervalues clinical services.
"Even relatively small changes in Medicare payment rules can have significant downstream effects on physician practices and patient access to care," the group explained.
HRA noted that the Medicare Patient Access and Practice Stabilization Act of 2025 (H.R. 879/S. 1640) was reintroduced in Congress in late February to help physicians combat this payment adjustment. The bill, which would delay the new –2.5% cut until 2030, follows months of advocacy from physician organizations warning that the adjustment could significantly reduce reimbursement for doctors. Many physician practices are already facing rising inflationary costs, and Medicare does not adjust payments to cover inflationary increases like it does for hospital payments.
This new legislation calls for CMS to provide empirical evidence to support the efficiency adjustment and to establish guardrails for how future reductions are calculated. There have been fears across medical groups that CMS could increase the efficiency cuts in the future without being required to make justifications.
"Medicare payment stability remains one of the most pressing policy issues facing physicians. Without structural reforms to the payment system, practices across the country may face difficult decisions about maintaining access to care for seniors," HRA stated.
HRA said it closely watches the Medicare Payment Advisory Commission (MedPAC), which recently held its March meeting. MedPAC recommendations often shape Congressional policy in future Medicare legislation on things like physician payments, Medicare Advantage and other Medicare spending.
2. New prior authorization policy restricts use of AFib ablation procedures
Carelon Medical Benefits Management, a utilization management company for Elevance Health (formerly Anthem) is raising concerns among electrophysiologists over its coverage for CPT code 93657, which is an add-on code for atrial fibrillation (AFib) ablation procedures. Under a policy update instituted in March, Carelon might consider the additional ablation work “not medically necessary” and may require a peer-to-peer discussion for approval of the code. HRA said policies like this could introduce new administrative barriers for complex ablation procedures that create delays in care for patients with persistent or difficult-to-treat AFib.
HRS members have already met with Carelon to discuss this topic.
3. Payment cuts threaten access to LAAO
HRS and other cardiology organizations continue to raise alarms with CMS over Medicare payment policies that reduce reimbursement for left atrial appendage occlusion (LAAO) procedures. Under the 2026 MPFS, work relative value units for LAAO procedures dropped by about 35% over two years when combined with other policy adjustments, HRA said.
Cutting payments for LAAO creates a barrier for treating patients and there are fears that it could ultimately increase long-term healthcare costs due to patients presenting with strokes.
4. Barriers still limit ambulatory ablation procedures
Although the HRS and the American College of Cardiology recently outlined best practices for performing cardiac ablation procedures in ambulatory surgery centers (ASCs), HRA said regulatory and reimbursement barriers still limit the expansion of these outpatient programs. The group said it is advocating for policies that support ASC EP procedures because of the need to make lower-acuity care more available to patients and to help free up hospital EP labs for more complex cases.
"Expanding access to EP procedures in ASCs could improve patient convenience, increase system capacity, and reduce healthcare costs," HRA said.
5. A permanent federal telehealth policy is needed
HRA and has joined other physician groups in urging Congress to continue the telehealth policies originally created during the COVID-19 pandemic. Being able to care for patients remotely has changed how physicians practice and made care much more convenient and efficient for patients. This is particularly true for patients living in rural or underserved areas.
However, Congress has had reservations about continuing payments for remote care because of concerns over potential fraud. While extensions have been approved for some COVID-era policies, there has still been no permanent fix.
HRA said some flexibilities have already expired. Others, like coverage for certain cardiac rehabilitation services delivered through telehealth, have been extended into the Medicare program. The group said remote care tools are playing an increasingly important role for patients with chronic cardiovascular conditions, including heart rhythm disorders that require ongoing home monitoring and remote patient management. Prior to COVID, a growing number of EP patients were already being selected for remote monitoring for their pacemakers, implantable cardioverter defibrillators (ICDs) and wearable ECG monitors.
6. NIH funding and research priorities
With the Trump administration canceling millions in National Institutes of Health (NIH) grants and attempting to force the NIH to conform its political policies to guide research rather than science, most physician and medical speciality groups want to see Congress protect science-based decision-making at the NIH and not allow the agency to be politicized.
HRA said it is keeping a close eye on the NIH advisory council meetings in March for the National Heart, Lung, and Blood Advisory Council, which advises NIH leadership on research priorities and funding direction. The group said these meetings play a key role in determining how federal research funding is allocated.
The Senate Health, Education, Labor and Pensions (HELP) Committee held a recent hearing titled “Modernizing the National Institutes of Health: Faster Discoveries, More Cures.” HRA said the hearing focused on how federal research infrastructure should evolve to accelerate medical innovation and improve the translation of scientific discoveries into clinical care. Both Republican and Democrat members of Congress have expressed interest in reforms aimed at strengthening NIH’s ability to support emerging areas of research.
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]