Advocacy in Action Newsletter
May 2026
An overview of the latest legislative, regulatory, and reimbursement issues impacting the EP field
Congress Continues Push for Medicare Physician Payment Reform
Momentum continues to build in Washington around long-term Medicare physician payment reform, with lawmakers in both chambers advancing legislation aimed at stabilizing the Medicare Physician Fee Schedule (PFS) after years of inflation-adjusted cuts. Much of the recent discussion has centered on the bipartisan Medicare Patient Access and Practice Stabilization Act, introduced in the House as H.R. 879 and in the Senate as S. 1640. The legislation would reverse the 2.83% Medicare physician payment cut that took effect in January and provide a partial positive payment update tied to rising practice costs. Physician organizations have framed the bill as an important short-term step while Congress debates broader structural reform.
At the same time, lawmakers are beginning to focus on longer-term modernization of the physician payment system itself. In March, Rep. Greg Murphy introduced the bipartisan Provider Reimbursement Stability Act (H.R. 8163), which would make targeted reforms to Medicare’s budget neutrality framework. The bill would increase the outdated budget neutrality threshold, require CMS to use more accurate utilization data when calculating payment changes, require more frequent updates to practice expense inputs, and limit large year-to-year swings in physician reimbursement.
Congress has also begun scrutinizing CMS’s newly finalized “efficiency adjustment,” a policy finalized in the CY2026 Physician Fee Schedule rule that applies a 2.5% reduction to many physician work RVUs based on assumed productivity gains. Physician groups have strongly criticized the policy, arguing CMS has not adequately demonstrated that procedural times or physician work have meaningfully decreased. In February, Rep. Ron Estes introduced H.R. 7520 to delay implementation of the efficiency adjustment while Congress and stakeholders evaluate the methodology behind the cuts.
These issues have also surfaced in ongoing discussions involving the Medicare Payment Advisory Commission (MedPAC), as well as conversations within the House Energy and Commerce Committee and the Senate Finance Committee regarding physician practice sustainability, inflationary pressure, and Medicare access challenges.
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Why it Matters: Electrophysiology practices continue to face increasing operational pressures, workforce shortages, rising staffing costs, and growing administrative burden tied to prior authorization and reporting requirements. Continued payment instability threatens long-term patient access to cardiovascular and arrhythmia care, particularly in community-based and rural settings where margins are already under strain.
New Federal Bill Targets Site-of-Care Barriers for EP Procedures
Representative Beth Van Duyne recently introduced the Outpatient Surgery Access Act(H.R. 8091), legislation aimed at reducing payment disparities between hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs).
The bill would direct CMS to expand the list of procedures eligible for ASC reimbursement and modernize payment policies that many physician groups believe currently discourage lower-cost outpatient care settings.
For the electrophysiology community, the legislation is particularly significant because advocates have increasingly pushed for broader ASC eligibility for procedures such as cardiac ablations and related EP interventions. Supporters argue that appropriately selected patients can safely undergo many procedures in ASCs while improving convenience, reducing costs, and preserving hospital capacity for higher-acuity care.
Hospital groups, however, have expressed concerns that continued migration of procedures away from hospitals could threaten financial stability for health systems that rely on outpatient procedural revenue to support emergency services and other community obligations.
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Why it Matters: Site-of-care policy is rapidly becoming one of the most important healthcare debates in Washington. Expanded ASC access could significantly reshape how and where electrophysiology care is delivered over the next decade.
Prior Authorization Scrutiny Intensifies Across Washington
Federal lawmakers and regulators continue increasing pressure on insurers over prior authorization practices and utilization management policies, particularly within Centers for Medicare & Medicaid Services-regulated Medicare Advantage plans.
Much of the congressional focus remains on the bipartisan Improving Seniors’ Timely Access to Care Act. The legislation would streamline prior authorization requirements in Medicare Advantage by requiring electronic prior authorization systems, improving transparency around denials and approvals, standardizing clinical criteria, and requiring plans to respond to certain requests within defined timeframes. The bill has broad bipartisan support (68 cosponsors in the Senate, and 280 in the House) as well as backing from major physician and hospital organizations.
Congressional scrutiny intensified further following continued reports from the HHS Office of Inspector General and Senate investigators finding high rates of overturned denials and concerns regarding inappropriate use of utilization management tools within Medicare Advantage plans.
The issue has also surfaced in broader congressional oversight discussions involving the Senate Finance Committee, House Ways and Means Committee, and Senate investigative panels, where lawmakers have increasingly questioned insurers and federal officials about delays in medically necessary care, denial transparency, and the growing use of algorithmic decision-making in coverage determinations.
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Why it Matters: Administrative burden tied to prior authorization remains one of the most significant frustrations facing physicians and patients alike. Delays in approvals can postpone procedures, increase staff workload, and create uncertainty for patients seeking specialized cardiovascular care. Prior authorization reform continues to be a leading advocacy priority for the EP community and broader physician organizations.
FDA Expands Focus on AI-Enabled Medical Devices
Federal regulators are continuing to refine oversight frameworks for artificial intelligence-enabled medical technologies, including tools relevant to cardiovascular and electrophysiology care.
The U.S. Food and Drug Administration has increased public discussion around Predetermined Change Control Plans (PCCPs), a regulatory approach designed to allow certain AI-enabled software products to evolve over time while maintaining regulatory oversight.
Physician groups – including HRS – are increasingly engaging with FDA leadership to ensure clinicians have visibility into how AI systems perform over time, how algorithm updates are communicated, and how transparency standards are established for clinical decision-support tools.
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Why it Matters: AI-enabled technologies are expected to play a growing role in cardiac monitoring, diagnostics, and procedural planning. Regulatory decisions made today may shape how clinicians interact with these tools for years to come.
What We're Watching in Washington
CMS Begins Early Work on 2027 Payment Policy
CMS has not yet released the CY2027 Medicare Physician Fee Schedule or OPPS/ASC proposed rules, but several issues from the CY2026 rulemaking cycle are already shaping the next round of advocacy. In the CY2026 PFS final rule, CMS finalized a –2.5% “efficiency adjustment” to work RVUs and intraservice time for most non-time-based services, a policy many specialty societies argue could systematically undervalue procedural and specialty care. CMS’s own CY2026 PFS summary says the agency finalized a five-year lookback period, resulting in a –2.5% efficiency adjustment for CY2026.
Site-of-care policy is also expected to remain a central focus. In the CY2026 OPPS/ASC final rule, CMS finalized significant changes to the ASC Covered Procedures List, including broader eligibility criteria and the addition of hundreds of procedures. For EP specifically, CMS finalized the addition of cardiac ablation procedures to the ASC Covered Procedures List, including several cardiac ablation and related EP services. HRS and HRA supported the additions while emphasizing appropriate patient selection and safety protocols.
Physician organizations are also focused on remote monitoring reimbursement, including CPT 93296, where advocates argue current payment assumptions underestimate the work associated with longitudinal device monitoring, alert review, troubleshooting, and patient management. Telehealth and virtual supervision policy will remain relevant as well: CMS finalized that, beginning January 1, 2026, direct supervision may be provided through real-time audio/video virtual presence for many services, excluding audio-only.
Finally, budget neutrality remains a major pressure point. The Provider Reimbursement Stability Act, H.R. 8163, would raise the Medicare Physician Fee Schedule budget-neutrality threshold, require claims-based corrections to utilization estimates, mandate more frequent practice-expense updates, and cap annual conversion-factor adjustments at ±2.5% beginning in 2027.
What We're Watching: Signals regarding future site-of-care policy, remote monitoring reimbursement, and additional physician payment reforms.
NIH Funding Discussions Continue During Appropriations Season
Appropriators in both chambers of Congress have begun early discussions around FY27 federal research funding levels. HRA continues to advocate for sustained investment in arrhythmia research, sudden cardiac arrest prevention, and implementation science.
What We’re Watching: Potential funding levels for the National Institutes of Health and the National Heart, Lung, and Blood Institute.
Growing Attention on Physician Workforce Issues
Federal and state policymakers continue examining physician workforce shortages, including barriers related to graduate medical education (GME) capacity, physician burnout, administrative burden, rural access, and physician mobility.
In February, the House Ways and Means Committee Health Subcommittee held a hearing titled “Advancing the Next Generation of America’s Health Care Workforce,” focused on physician shortages, Medicare-funded residency caps, rural workforce challenges, and long-term training pipeline issues. Witnesses and lawmakers discussed projections showing the U.S. could face a shortage of up to 187,000 physicians by 2037, with particularly severe shortages in rural communities.
Several workforce-related bills continue advancing in Congress, including the Resident Physician Shortage Reduction Act (H.R. 4731 / S. 2439), which would expand Medicare-supported residency slots over multiple years, and continued discussions around physician burnout and administrative burden, including a February hearing before the United States Senate Special Committee on Aging titled “The Doctor Is Out: How Washington’s Rules Drove Physicians Out of Medicine.” The hearing focused heavily on prior authorization, Medicare Advantage administrative complexity, and the relationship between regulatory burden and workforce attrition.
At the state level, physician non-compete reform continues gaining momentum, with lawmakers in multiple states considering legislation limiting restrictive employment agreements for physicians and other healthcare professionals. Workforce mobility and consolidation pressures are increasingly being discussed alongside broader healthcare access concerns.
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What We’re Watching: Whether physician workforce concerns (particularly around burnout, training capacity, and physician mobility) begin influencing broader Medicare payment reform, GME expansion, and healthcare access legislation in Congress.