Why electrophysiologists needed a champion in Washington
The Heart Rhythm Society (HRS) recently launched a dedicated advocacy group, Heart Rhythm Advocates (HRA), to champion the needs of cardiac electrophysiologists (EPs) and their patients. HRS President Kenneth A. Ellenbogen, MD, director of clinical cardiac EP and pacing with Virginia Commonwealth University, unveiled the initiative in November, highlighting its goal to address policy challenges, ensure fair reimbursement and advocate for equitable patient care and access. He discussed the new organization with Cardiovascular Business at the American Heart Association (AHA) 2024 meeting.
“For over 45 years, HRS has supported the electrophysiology community, but there’s a limit to what we can do as a nonprofit,” Ellenbogen explained.
With this new initiative, the aim is to advocate for the fair treatment of EPs in terms of pay, equitable patient access to care, and the coverage for the latest technology advancements.
"We hope that the entire cardiology community realizes the important work we do and comes together to support us. We're going with a unified electrophysiology community with the old basketball saying from Coach K from Duke, 'a fist is more powerful than a finger.' So we hope we get the EP community mobilized and people pay attention to this and realize the time to have a fight is not when the cuts are on the table, but to explain to people how important and how complex are the things we do," he explained.
Growing crisis in EP
Electrophysiologists face mounting challenges, including significant reimbursement cuts the past few years that threaten the viability of the field. These cuts are even making some cardiologists think twice about training in the subspecialty. Ellenbogen noted that EPs train for 12 years, longer than any other subspecialty, to be able to perform surgery, catheter-based interventions and implant heart rhythm devices.
"We are really on the cutting edge of providing life-saving therapies. But at the same time, we're being faced by these terrible reimbursement cutbacks. We obviously are very concerned because as you may be aware, the prevalence of atrial fibrillation (AFib) continues to increase. It's a pandemic. So we have to be able to attract the best and the brightest doctors, and you can't do that if your field is being gutted by reimbursement cuts," he said.
There are concerns about the long training that includes years of not making much money when paying back hefty loans. There were major Medicare cuts to EP in 2023 that included a 35.7% reduction in AFib ablations, 32.7% for superventricular tachycardia (SVT) ablations, 26.67% for add-on ablations, and an 8.35% reduction for ventricular tachycardia ablations. At the same time, between 2021 and 2023, the Centers for Medicare and Medicaid Services (CMS) increased payments for these same procedures to hospitals by 9.4%. Between 2022 and 2024, EP saw patient cuts up to 40% for some of its main procedures.
Advocacy priorities for HRA
Ellenbogen said HRA will focus on several key areas. These include calls for fair reimbursement and reflecting equitable compensation in light of the extensive training and high-risk procedures EPs perform.
Patient access is another priority. As Medicare continues to make cuts, access may be limited to only those who can pay for it out of pocket due to costs no longer being matched by CMS payments. Some providers may also decide to no longer accept Medicare patients.
While EP technologies have made major advancements in just the past decade, payment coverage of those technologies has been lagging, so patients are sometimes not treated with the most effective therapy available. HRA will pressuring insurers to cover innovative treatments and promote outpatient procedures to reduce wait times.
"We hope to see ambulatory surgical centers being able to do more catheter ablation procedures so patients don't have to wait months and months sometimes to get into hospital-based electrophysiology labs. We will also have more technologies to be able to maybe do procedures without using general anesthesia, which will be better for our patients and make the procedure even safer. We hope to get fair reimbursement for some of the new procedures that we're developing now," Ellenbogen said.
HRA will offer a more unified voice
He emphasized the importance of collective action. “If you’re not at the table, you’re on the menu. We need to mobilize the EP community and the broader cardiology field to stand together. A unified front is more powerful than a fragmented one,” Ellenbogen explained.
Read more in the article Heart Rhythm Society launches new group focused on EP advocacy.
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