News | Published: Tuesday, May 5, 2026
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At CV Transforum Spring’26 ACC and MedAxiom leaders outlined a rapidly evolving policy environment that could significantly reshape cardiovascular care delivery, reimbursement and physician practice models over the next several years. The panel of speakers included Nicole F. Knight, LPN, CPC, CCS-P, executive vice president of Revenue Cycle Solutions and Care Transformation Services at MedAxiom; Nick Morse, MBA, division vice president of Advocacy and Government Affairs at the ACC; and Samuel O. Jones IV, MD, MPH, FACC, director of the electrophysiology (EP) lab at Chattanooga Heart Institute.
A central focus of the discussion was the 2026 Medicare Physician Fee Schedule (MPFS) final rule, which included a negative 2.5% efficiency adjustment alongside a temporary increase in the conversion factor. While this may provide short-term financial relief for some practices, Jones cautioned that the benefits vary widely depending on practice structure. Speakers suggested downward pressure on reimbursement could return as soon as 2027.
Another major theme was the growing push toward site-neutral payment policies. The issue has gained rare bipartisan attention in Washington, DC, signaling potential legislative movement. Adjustments to facility-based reimbursement and practice expense calculations are already creating a “mixed bag” of financial impacts, particularly for hospital-owned outpatient departments. The speakers expect continued efforts to equalize payments across settings, despite resistance from health systems.
Changes in reimbursement tied to site of service were also highlighted as a major issue. Adjustments to facility-based practice expense payments are creating mixed financial effects, particularly for facilities that bear higher operational costs. At the same time, policymakers are continuing to push toward site-neutral payment, an issue gaining significant bipartisan attention in Washington, DC. While regulatory changes so far have been incremental, the panelists do not expect the issue to fade.
The outpatient rule is another area to watch, with a phased elimination of the inpatient-only list expected to continue through the 2027 cycle. This shift is expanding the range of procedures performed outside traditional inpatient settings. For example, EP ablation was recently added to the ambulatory surgery center Covered Procedures List. Speakers noted that while this creates new opportunities, it also raises important questions about quality, ethics and appropriate site selection. State-level differences – particularly around Certificate-of-Need (CON) laws – will shape how these changes play out.
Broader state activity is accelerating across multiple fronts. Efforts to repeal physician noncompete agreements are gaining traction, with progress in several states and continued legislative momentum nationwide. At the same time, CON reform efforts in states such as North Carolina, South Carolina and Tennessee aim to reduce restrictions on care delivery. Federal agencies have also weighed in, with policymakers citing workforce mobility and rural access as key drivers.
Legislative efforts related to cardiac care are also advancing. Multiple states are considering or passing laws to expand access to automated external defibrillators (AEDs), often driven by advocacy following sudden cardiac arrest events in young individuals. However, proposals such as widespread pre-participation ECG screening remain controversial due to concerns about false positives. Speakers emphasized the need to better educate lawmakers on evidence-based approaches.
At the federal level, Congress continues to consider reforms to physician payment, including proposals to repeal the efficiency adjustment and establish more predictable, inflation-based updates. Telehealth flexibilities are expected to remain in place through at least 2027, supporting expanded access to services such as cardiac rehabilitation.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is advancing new value-based care models. A mandatory five-year Ambulatory Specialty Model (ASM) focused on advanced heart failure (HF) is scheduled to begin in 2027. The model will assess providers on cost, quality and other performance measures using Medicare claims data. Concerns remain around attribution in team-based cardiology care, as well as the inclusion of total cost measures spanning hospital care, medications and post-acute services. Providers selected for the model will be exempt from MIPS reporting but will face new reporting and performance requirements.
Additional initiatives, including the CMS Access Model, aim to expand the use of digital tools for managing chronic conditions such as HF, hypertension, diabetes and hyperlipidemia. These models may involve both physicians and third-party vendors, with reimbursement tied to patient outcomes.
Finally, the growing use of artificial intelligence (AI) is expected to impact both clinical care and reimbursement. While AI may improve efficiency in areas such as documentation and imaging, speakers cautioned that it could also lead to reduced physician reimbursement if payers determine that less physician time and effort is required. At the same time, regulatory approaches to AI remain fragmented, with federal agencies and states pursuing different strategies.
Overall, the speakers described the current environment as a “fascinating time” for cardiology, marked by rapid policy change, increasing complexity and the need for ongoing advocacy.
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