Healthcare advocacy in 2025: American Society of Echocardiography reviews a busy year
2025 was a busy year for advocacy efforts in the world of cardiovascular imaging, according to the American Society of Echocardiography (ASE). Many of the policies ASE focused on throughout the year were priorities for other medical societies as well.
Addressing Medicare cuts
The society actively supported the Medicare Patient Access and Practice Stabilization Act (HR 879), which aimed to eliminate the 2025 conversion factor cut and provide a 2% payment update. ASE sent a letter of support to the bill sponsors in February and sent multiple coalition letters urging Congressional action. While this bill did not advance, the society said there was a significant breakthrough in June when the House included physician payment provisions in the One Big Beautiful Bill Act (HR 1).
HR 1 proposed a 2.5% update for 2026 and a 10% Medicare Economic Index (MEI) adjustment beyond 2026. ASE sent letters to both House and Senate Republican leadership, thanking them for including these provisions, while advocating for a permanent solution calling for annual MEI-based updates to the conversion factor. While hospitals get inflationary increase adjustments, physicians do not, which the American Medical Association (AMA) said has helped contribute to a loss of 33% in revenue since 2000. AMA and ASE agree this trend is not sustainable.
CMS changes cardiac ultrasound payment rules
In September, ASE submitted comments on two significant policy changes found in the 2026 Medicare Physician Fee Schedule that were not addressed. It is believed these updates will have a negative impact on echocardiography practices. The first issue is a new "efficiency adjustment" that will reduce work values by up to 2.5% for all non-time-based services, including echocardiography procedures. The Centers for Medicare and Medicaid Services (CMS) said this measure was created because doctors should become more efficient at what they do over time, and with the addition of new technologies designed to speed workflows. Medical societies overall have criticized this measure as a way the government is trying to justify payment cuts to doctors.
"ASE strongly opposed this adjustment, arguing that the underlying assumption, that services become more efficient over time, contradicts peer-reviewed evidence showing 90% of CPT codes maintained the same or longer operative times," ASE's advocacy team wrote in a letter to members.
CMS will also implement significant changes to the practice expense methodology for facility-based services. ASE said this changes will result in substantial payment reductions for hospital-based echo services, with interventional echocardiography facing estimated cuts of up to 11%. This prompted the society to join a coalition of societies in letters urging Congressional action to halt both the efficiency adjustment and practice expense cuts before Jan. 1, 2026.
There also will be a change in the outpatient cardiovascular services in 2026. Some transesophageal echo (TEE) codes are being added to the ambulatory surgical center’s covered procedures list in 2026 Hospital Outpatient Prospective Payment System (OPPS) final rule.
Growing clinical workforce shortages
Despite a growing shortage of cardiologists and sonographers in the U.S., federal policy did not do much to help the situation in 2025. ASE, like many medical societies across specialties, prioritized workforce issues in advocacy efforts in 2025 with support for measures to address additional physician training, lifting visa restrictions and creating better student loan access.
Medicare funding supports the vast majority of physician residency positions to ensure there is an adequate supply of doctors. But with the current administration and a Republican-controlled Congress, there has not been little support for expanding Medicare spending to increase the number of residency positions.
ASE said it joined the Alliance of Specialty Medicine and Graduate Medical Education (GME) Advocacy Coalition to in support of the Resident Physician Shortage Reduction Act (S 2439 / HR 3890). These bills call for an annual increase of 2,000 Medicare-supported GME residency slots over seven years. The alliance is also advocating for 25% of slots to be designated for specialty medicine.
The Trump administration implemented a $100,000 fee in 2025 for H-1B visa applications. This will significantly impact healthcare systems looking to hire foreign trained doctors to enter the U.S. to take jobs in areas that American trained physicians do not want in rural and underserves and economically blighted regions. ASE joined the AMA in urging the Department of Homeland Security to exempt physicians under the new visa restriction.
"H-1B physicians are critical to addressing physician shortages and disproportionately serve underserved and rural communities," ASE said.
Student loan access is also plays an important role in covering the high costs associated with attending medical school and residency training. ASE was part of a coalition of medical groups sending letters opposing legislation that would eliminate the Grad PLUS program and impose new limits on direct loan borrowing for physician residents. ASE urged the Department of Education to preserve the long-standing federal loan exception that allows medical students to borrow additional unsubsidized direct loans above statutory limits. Without these provisions, there is fear many students may see medical school as too expensive and follow other career paths and further exasperate the physician shortage.
ASE also supported the Specialty Physicians Advancing Rural Care (SPARC) Act (S. 1380/H.R. 4681). The bill would establish a loan repayment program of up to $250,000 over six years to attract specialty physicians to practice in rural communities where the U.S. is currently facing the biggest shortages of clinicians.
Prior authorization, AI and NIH funding
The number of prior authorizations for exams and procedures has skyrocketed in recent years, greatly adding to administrative burden for physicians and the healthcare system. Physician groups across the board say prior authorizations lead to delays in patient care and the decisions are often being made by insurance company physicians who are outside the speciality and scope of the care decisions they are making. For this reason, ASE supported the Reducing Medically Unnecessary Delays in Care Act (HR 2433) that would require prior authorization decisions to be made by board-certified physicians in the same specialty as the treating physician. The bill also would require timely responses.
ASE also joined coalition healthcare groups in letters supporting the Improving Seniors' Timely Access to Care Act (HR 3514/S. 1816). This bill would establish electronic prior authorization systems for Medicare Advantage plans and decision transparency and faster timelines.
One win on the prior authorization front came in November, when the House Committee on Appropriations adopting an amendment to halt funding for the the Wasteful and Inappropriate Service Reduction (WISeR) Model, which would have introduced prior authorization into Medicare fee-for-service. CMS said WISeR would use AI review prior authorization requests to make sure they are approariate and in an effort to reduce wasted spending on unnecessary medical services. ASE commended the committee and said WISeR did not contain adequate safeguards.
In artificial intelligence (AI) policy for cardiovascular imaging, ASE has emerged as a leading voice on policy concerns. In March, ASE submitted recommendations ion October to the National Coordination Office for developing an AI action plan. The letter called for standardized AI terminology, improving the FDA AI approval process, the need for human clinician oversight for any algorithms, the need for continuous monitoring for drift and hallucinations, and policy that clarifies AI liability concerns.
The Trump administration's attempt to slash federal funding for the National Institutes of Health (NIH) has been a major concern across healthcare and is opposed my all the major medical societies. ASE said it has worked diligently to protect federal research funding for cardiovascular ultrasound. In June, ASE joined the Ad Hoc Group for Medical Research in urging Congress to reject the proposed $18 billion in NIH budget cuts. It also supported the Financial Accountability in Research (FAIR) model for essential research costs and requested at least $47.2 billion for NIH in fiscal year 2026.
ASE sent surveys to its members to learn more about the funding interruptions they have encountered and how cuts have impacted their ability to conduct 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]