HRA Statement for the Record

Heart Rhythm Advocates (HRA) appreciates the opportunity to submit this statement for the record regarding the Subcommittee’s hearing examining the Medicare Physician Fee Schedule (MPFS), the Medicare Access and CHIP Reauthorization Act (MACRA), and opportunities for physician payment reform.

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HRA is a national advocacy organization dedicated to improving patient access to evidence-based cardiac electrophysiology care, supporting policies that strengthen the cardiovascular workforce, and advancing sustainable healthcare delivery models capable of providing timely treatment for patients with heart rhythm disorders. Our physician members diagnose and treat patients suffering from atrial fibrillation, ventricular

arrhythmias, sudden cardiac arrest syndromes, conduction disorders, and other serious cardiovascular conditions affecting millions of Americans.

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HRA appreciates the Committee’s attention to the growing instability within the Medicare physician payment system and the broader operational challenges facing physician practices participating in Medicare. As discussed throughout the hearing, Medicare physician reimbursement has failed to keep pace with inflation and rising practice costs, while physicians continue to face growing administrative and regulatory burdens. These

pressures increasingly threaten patient access to care, particularly in highly specialized fields such as cardiac electrophysiology that require substantial investments in workforce training, digital infrastructure, remote monitoring systems, advanced procedural capabilities, and highly specialized clinical staffing.

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For electrophysiology practices, these challenges are particularly acute. Cardiac electrophysiologists manage some of the most medically complex Medicare patients, including individuals at risk for stroke, heart failure, and sudden cardiac death. At the same time, the specialty has experienced rapid technological evolution, requiring physicians and practices to invest heavily in remote cardiac monitoring platforms, implantable device

management infrastructure, data review systems, cybersecurity protections, interoperability requirements, and specialized personnel capable of managing increasingly sophisticated cardiovascular technologies.

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Despite these growing operational demands, reimbursement instability within the MPFS continues to create uncertainty that undermines long-term planning and threatens the sustainability of community-based specialty care. In many regions of the country, patients already face lengthy delays for electrophysiology consultation and procedures due to workforce shortages, increasing cardiovascular disease burden, and rising rates of atrial

fibrillation associated with an aging population. Continued instability within the Medicare physician payment system may also accelerate consolidation within the healthcare marketplace, reducing the viability of independent specialty practices and shifting care toward higher-cost settings. Preserving access to community-based and outpatient cardiovascular care is important not only for patient access, but also for long-term healthcare system sustainability.

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Electrophysiology practices across the country are experiencing workforce shortages, longer wait times for specialty consultation and procedures, increasing administrative burden associated with prior authorization and utilization management, and growing difficulty maintaining independent and community-based practice operations amid substantial reimbursement instability affecting key electrophysiology services. Recent

Medicare payment proposals have included reductions exceeding 9 percent for atrial fibrillation ablation services and approximately 27 percent reductions in work RVUs associated with left atrial appendage closure procedures, despite the demonstrated clinical value of these therapies in reducing stroke, hospitalization, and long-term healthcare costs. 

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We therefore appreciate the Committee’s focus on identifying long-term structural reforms to the Medicare physician payment system rather than continuing the cycle of temporary short-term payment adjustments. HRA supports efforts to create a more stable and predictable physician payment framework that better reflects inflationary pressures and the real-world costs of delivering modern specialty medical care.

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Specifically, HRA supports the goals of the Strengthening Medicare for Patients and Providers Act (H.R. 6160), which would help establish a more rational and sustainable physician payment update structure tied to the Medicare Economic Index (MEI). We also support continued Congressional efforts to streamline prior authorization and reduce unnecessary administrative burden through legislation such as the Improving Seniors’

Timely Access to Care Act (H.R. 3514). These reforms would help preserve patient access to timely specialty cardiovascular services while reducing delays that can adversely affect clinical outcomes.

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Additionally, HRA encourages policymakers to consider the unique operational realities associated with remote physiologic monitoring and digital cardiovascular care infrastructure. Remote monitoring of implantable cardiac devices and arrhythmia patients has become a standard component of evidence-based cardiovascular care and is now recommended throughout major clinical guidelines. These services improve patient safety, reduce avoidable hospitalizations, facilitate earlier identification of clinically significant cardiac events, and support more efficient long-term management of chronic cardiovascular disease.

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However, the current Medicare payment framework often fails to adequately recognize the substantial clinical and operational resources required to safely deliver these services. Remote monitoring of cardiac implantable electronic devices requires continuous clinical review, patient communication, alert management, data interpretation, cybersecurity protections, technical support infrastructure, and coordination among physicians, nurses, and allied health professionals. In many cases, the real-world staff time and infrastructure demands associated with remote cardiac monitoring exceed existing Medicare assumptions regarding practice expense inputs and clinical labor requirements.

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As Congress continues evaluating opportunities for MACRA and MPFS reform, HRA

encourages the Committee to prioritize policies that:

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• Improve long-term physician payment stability and predictability;

• Reduce administrative burdens associated with prior authorization and utilization management;

• Preserve patient access to community-based and outpatient specialty care;

• Support the continued development of remote monitoring and digital health infrastructure;

• Promote interoperability and modernization of cardiovascular care delivery systems; and

• Ensure Medicare policies promote timely access to evidence-based cardiovascular care for an aging patient population.

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HRA appreciates the Committee’s leadership in examining these issues and looks forward to continued collaboration with Congress on policies that strengthen patient access to high-quality cardiovascular and electrophysiology care while supporting a sustainable and modernized Medicare physician payment system.