Reimbursements, non-compete clauses and more: SCAI focused on key policies in interventional cardiology

Physician Medicare payment reform

At the top of SCAI’s advocacy list is support for the Medicare Patient Access and Practice Stabilization Act of 2025 (H.R. 879), a bipartisan bill that seeks to reverse a nearly 3% reduction in Medicare physician payments. This bill failed to get support at the end of 2024, but has been reintroduced and has the support of all major medical societies. The bill also includes a 2% annual inflation adjustment and provisions to better reflect rising practice costs.

"If you look back over the last two decades, reimbursement without inflation adjustments means physician payments are down 20-25%. The bill addresses the 3% cut to physician pay and will keep us neutral, and also included 2% adjustment for inflation to really address practice costs. The practice we're having to deal with inflation here and payments for practice are going down. And so this bill's very important to help address all those things,” Hermiller, director of the transcatheter structural heart program at Ascension St. Vincent Heart Center in Indianapolis, explained.

Peer review reform

SCAI is also pushing for changes to the current peer review system, which he criticized as being vulnerable to abuse. While initially created to enhance quality of care in hospitals, is not an open or transparent process. The way that peer review is set up also makes it not legally discoverable, so the process of reviews is often done in the shadows, he explained.

"I think peer review often is sham review. The bill had hospital quality in the title, but it really empowered them to hire the judge and the jury for peer review of physicians. Often it was weaponized to help deal with physicians at the hospital who brought up issues around quality in the hospital or staffing in the hospital. And this needs to be reformed where it becomes a true peer review of those that do the procedures," Hermiller said.

SCAI is working with other medical societies to advance legislation and regulatory reforms to restore due process and enhance transparency in peer review cases.

Medical education loan interest relief

Another key focus is a bill in Congress for resident loan interest deferment, an effort to ease the financial burden on young physicians-in-training. If passed into law, it would defer interest accrual during residency when thee clinicians are not making enough money to pay for their education loan payments.

"We're facing a really a giant issue with respect to having enough physicians to do the work. Part of it is these huge loans for these kids come out of medical school and college and they have to defer those during their residencies because they're not getting paid enough. This bill allows them to defer payment without incurring the interest, which can be considerable for an interventional cardiologist who have training for another six or seven years on top of medical school," Hermiller said.

Reducing financial stress during training could also encourage more physicians to enter underserved specialties or practice in rural areas, rather than being forced to pursue higher-paying fields solely to manage debt, he said.

Elimination of non-compete clauses for physicians

SCAI is renewing efforts to abolish non-compete agreements for physicians, arguing they are increasingly incompatible with today’s consolidated healthcare landscape.

"It really limits our ability to choose what we want to do. In fact, we don't have any leverage with the hospital if they can say, well, you got to get out out of the area if you want to practice. It's not fair," Hermiller explained.

While federal efforts have met resistance in the courts, SCAI is working state-by-state with allied organizations to eliminate these restrictions and preserve physician mobility.

Physician wellbeing and mental health

SCAI is also highlighting the urgent need for better support of physician mental health and wellness, especially in the wake of the COVID-19 pandemic. SCAI has hosted webinars and initiatives around burnout, second victim syndrome and the mental toll of adverse patient events. The organization is also advocating for protections that would allow physicians to seek mental health support without fear of punitive action by licensing boards.

"We have had a big initiative around the emotional and work-related challenges in wellness and burnout, which our survey shows impacts 30-50% or our members. If you look at physicians, and we certainly deal with it from interventional cardiology, the stress of the procedures and complications, but then we're still at home at midnight on the computer trying to take care of computer records There are tremendous challenges and that's going to contribute to the lack of physicians, that it's going to be a tsunami in the next decade," Hermiller said.