Year in Review: Reimbursement, Funding Cuts Mark Top Policy & Practice News

Healthcare delivery, and importantly the way for which it is paid, continues to challenge the field of cardiology, with several controversial policies and reimbursement cuts making headlines in 2025. New policies affecting research funding also rocked the field of cardiovascular science this year.

In the first quarter of 2025, the new Trump administration sowed uncertainty among CV researchers by cutting funding for a wide swath of federal scientific agencies. Cardiologists responded with surprise and confusion and offered predictions about how funding freezes would likely affect patient care.

By April, more chaos ensued with the Department of Health and Human Services canceling funding for the well-respected and long-running Women’s Health Initiative study before reversing course less than a week later.

And in July, TCTMD published a familiar yet mostly disappointing story detailing how the US Centers for Medicare & Medicaid Services (CMS) proposed cuts for the 2026 Medicare Physician Fee Schedule (PFS) would affect cardiovascular care.

The One Big Beautiful Bill Act (OBBBA), passed into law in July, would also likely have negative implications for the field, William Van Decker, MD, argued in an Off Script blog. The American Society of Nuclear Cardiology (ASNC) launched a campaign over the summer to oppose CMS’ proposed 57% reimbursement cuts for pyrophosphate/amyloid imaging.

Costs of CV Care

All these policy changes were announced amidst studies showing that CVD remains the leading cause of death globally, yet access to care remains uneven. Additionally, as private equity gobbles up more US hospitals, patient experience seems to worsen and more-profitable cardiac caths are being prioritized. An uptick in cardiac mortality since the COVID-19 pandemic has led some researchers to question the optimization of the nation’s healthcare delivery.

The US is paying approximately $100 billion annually to treat heart disease, and clinicians are now tasked with being more cost conscious and paying more attention to their carbon footprint. Incomes may have risen for cardiologists in 2024, but they report additional caseload demands.

Medication costs also remain a sore point. For many Medicaid patients with type 2 diabetes, specifically, cardioprotective drugs like sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are inaccessible. Several initiatives focused on greater worldwide use of polypills have been proposed to help solve accessibility and adherence issues, especially in underserved areas.

Outside of costs and reimbursement, a major blow to cardiology came in February when the American Board of Medical Specialties (ABMS) refused to approve the American Board of Cardiovascular Medicine (ABCVM) as a new certifying body for cardiologists. The ABCVM announced it would continue to pursue other avenues to help increase equity and fairness for physicians, especially with regard to maintenance of certification (MOC) requirements.

Looking specifically at workplace issues, new data from the ERGO-CATH study show how interventional cardiologists are still struggling with cervical injuries as a result of wearing lead protection in the cath lab. A survey distributed by the Society for Cardiovascular Angiography and Interventions discouragingly showed no change in the rate of orthopedic and radiation injuries for cath lab staff over the past decade. Novel radiation shielding systems are making waves, but hospitals must agree to pay for these technologies. New studies also have given insight into how clinicians can use digital tools to improve well-being.

In addition, more information has come to light regarding disparities involving women in cardiovascular medicine, notably with regard to grand rounds lectures, compensation, and enrollment in clinical trials.

On the training front, the second annual interventional cardiology match this month identified potential pipeline issues. Heart failure experts have proposed a combined “interventional heart failure” training pathway to help fill a growing gap in clinicians available to treat these complex patients. One fellow built a simulation to help his colleagues better prepare for their first night float, and surgeons are turning to TikTok to help with patient education. And many clinicians spoke to the need to continue meeting in person, despite all the advantages that come with learning by Zoom.

Lastly, the US Food and Drug Administration proposed simplified nutrition labels on packaged foods at the beginning of the year and the American College of Cardiology (ACC) published a guidance document in December supporting these changes, citing the potential for CV health improvements.

Kramer’s Takeaways

Christopher Kramer, MD (University of Virginia School of Medicine, Charlottesville), president of the ACC, told TCTMD his main takeaway for 2025 was that a lot of change is on the horizon regarding “the interface between the government and how cardiologists get paid going forward.”

Things started out rosy with OBBBA and the 2.5% increase in the conversion factor for reimbursement for physician services that made up for cuts enacted in the 2025 Medicare PFS, he said, “but all of it was undone” with the 2026 PFS announcement.

“The other big unknown is 10 to 11 million people are going to lose Medicaid,” said Kramer, referring to the government’s changes to eligibility. “That’s going to be huge, and patients are just going to show up in ERs. The ERs are going to be overrun. Certain smaller rural hospitals are probably going to close.”

Regarding the ABCVM, Kramer said “there may be some remaining options out there that we’re still looking into. We haven’t given up hope completely.”

Some positive news includes CMS’ approval of ablation procedures for atrial fibrillation in ambulatory surgical centers, according to Kramer. He also advised cardiologists to take note of the new ambulatory specialty model for heart failure slated to go into effect in 2027, with details to be announced this January.

“People need to pay attention into 2026 to set their practices up because you can take as much as a 9% hit on your care of heart failure patients if your scores are poor,” he said. “If you’re not paying attention and not dotting your i’s and crossing your t’s, that could be a real blow to your practice.”

Lastly, artificial intelligence (AI) is seeping more and more into healthcare workflows and practice patterns, and cardiology is no exception. “AI is not going to replace physicians, but physicians who don’t use AI will be replaced,” Kramer said.