In 2025, CMS Final Rule Will Bring ‘Death by a Thousand Cuts’ to Cardiologists

The 2025 physician fee schedule (PFS) announced by the Centers for Medicare and Medicaid Services (CMS) last month is set to reduce reimbursements by almost 3%: the cardiology community warns these cuts will continue to impact care.

Though one win coming next year is a doubling of reimbursement for coronary computed tomography angiography (CCTA), the rest of the news is mostly negative for the cardiovascular field.

The PFS conversion factor, the metric that guides how CMS reimburses physicians for services, is dropping by 2.83%: from $33.2875 in 2024 to $32.3465 in 2025. Also, telehealth coverage that was initiated during the COVID-19 pandemic and extended through this year will end, with telehealth only being reimbursable in 2025 in certain rural and underserved regions.

“I refer to it lovingly as death by a thousand cuts,” American College of Cardiology President Cathleen Biga, MSN, RN (Cardiovascular Management of Illinois, Woodridge), told TCTMD. “Unlike any of our other colleagues within the healthcare economic system who always get increases, the physician schedule just continues to get hammered. And yet our costs are very similar to our hospital colleagues: labor costs, postpandemic supply costs, real estate costs, and the complexity of our patients within the outpatient ambulatory setting just continue to escalate.”

Year after year, the same story plays out on repeat: CMS announces cuts, then stop gap measures are introduced, but physicians are left to suffer the continuing uncertainty, according to Joseph C. Cleveland, MD (University of Colorado Anschutz Medical Center, Aurora), who chairs the Society of Thoracic Surgeons Council on Health Policy and Relationships.

“This current payment system is just egregious in the sense that it puts patient care and practice sustainability at risk,” he told TCTMD. “What CMS, Medicare, and our elected officials are forcing upon America is an unstable and unsure health care system. We cannot continue doing this.”

This current payment system is just egregious in the sense that it puts patient care and practice sustainability at risk. Joseph C. Cleveland

Likewise, Arnold Seto, MD (Long Beach VA Medical Center, CA), co-chair of the Society of Cardiovascular Angiography and Interventions Advocacy Committee, told TCTMD in an email that the 2025 PFS represents “another nail in the physician office coffin.” As an example, he said, inflation is taken into account for other sites of services, but not for physicians.

“Ultimately, doctors have been hurt by 20 years of reimbursements failing to keep up with inflation and now with office expenses increasing significantly, we're at the limit of tolerance,” Seto explained. “If we want Medicare patients to have access to high-quality care, permanent Medicare physician-fee-schedule reform is needed.”

Short- vs Long-term Fixes

As in other years, new legislation has already been introduced to try and stave off some of the worst short-term effects of next year’s CMS cuts.

“Every year we ask Congress for the so-called ‘doc-fix,’” Seto said. “Many years we get half or two-thirds of a loaf. We hope that the lame-duck session of the 118th Congress will at least provide some relief from the 2.8% scheduled PFS cuts.”

Introduced last month, HR 10136, or the “Promoting Fairness for Medicare Providers Act,” would create a new payment system for office-based physicians. Seto said this bill “might be more practical than some of the site-neutrality solutions circulating in Congress.”

If we want Medicare patients to have access to high-quality care, permanent Medicare physician-fee-schedule reform is needed. Arnold Seto

Site neutrality is the growing movement within healthcare to align Medicare payments for hospital outpatient services regardless of where care is delivered. Two US senators released a plan last month for how they might bring about change, and states like New York are also weighing legislation along these lines.

“Site neutrality isn't just about imaging; it has to do with drugs, infusions, and all kinds of different things,” Biga said. “I think it's critical that we continue to educate our physicians on site neutrality and what that really means.”

Also, HR 10073, or the “Medicare Patient Access and Practice Stabilization Act of 2024,” might provide some relief, Biga said.

Ultimately, Cleveland said he’d like to see more long-term solutions for the same problem that physicians face every year. “The short-term relief that the House and Senate are considering is obviously essential,” he said. “What I would look forward to in 2025 is: let's stop talking about these short-term patches, and let's come up with a viable, long-term solution for physician reimbursement that will continue the access for patients and the stability of medical practices so that we can basically do what we're trained to do, which is take care of patients with the number one killer, cardiovascular disease, in the United States.”

Biga agreed. “This has to be fixed legislatively, in my opinion. There has to be a permanent fix,” she said. “Last year was one of the first years they mitigated it, but they didn't reverse it. So, we still had a hit. We keep talking about the sustainability of physician practices and what that's going to look like. This is a key indicator.”