A Cardiologist’s Open Letter on Payment Reform

Dear lawmakers,

I am writing as a cardiologist who sees the consequences of health policy in exam rooms, hospital corridors, and waiting rooms every day. Medicare payment reform may sound like a technical debate about fee schedules, conversion factors, and budget targets. For patients with heart disease, it is a question of whether timely, specialized care remains available in their communities.

Cardiovascular disease requires continuity. A patient recovering from a heart attack may need medication management, diagnostic testing, cardiac rehabilitation, and repeated follow-up. Someone with heart failure may need close monitoring to prevent an emergency admission. When reimbursement fails to reflect the time, staffing, technology, and coordination involved in this work, practices are forced to make difficult choices that can affect access.

I urge Congress and federal policymakers to treat physician payment as an access issue. Sustainable reimbursement is essential to preserving cardiology services, supporting medical practices, and protecting patients who rely on Medicare.

Payment policy reaches far beyond the billing office

A reduction in the Medicare physician fee schedule does not affect a single line on a financial statement. It can influence whether a practice keeps a cardiac nurse, offers same-week appointments, invests in diagnostic equipment, or continues serving a rural or underserved area. These decisions accumulate until patients face longer waits, fewer specialists, or longer travel for care.

Cardiology practices also absorb expenses that are easy to overlook in a payment discussion. Clinical staff coordinate referrals, review test results, manage prior authorizations, educate patients, and respond to urgent symptoms. Electronic health record requirements, cybersecurity, malpractice coverage, rent, and equipment maintenance add to the cost of delivering care.

A payment system that ignores these realities places pressure on the entire care team. Physicians may be asked to see more patients in less time, while practices postpone hiring and technology upgrades. That model is especially dangerous for older adults with multiple conditions who need careful evaluation rather than rushed encounters.

An open letter grounded in patient care

As a cardiologist, I accept the responsibility to provide evidence-based treatment and use healthcare resources wisely. I also recognize that responsible stewardship requires a functioning delivery system. When professional services are undervalued, the system does not become more efficient automatically. It may simply shift costs into emergency departments, hospitals, caregivers, and patients.

Medicare beneficiaries deserve access to specialists who can identify warning signs before a manageable condition becomes a crisis. They deserve a choice of clinicians, clear explanations of treatment options, and follow-up that reflects the seriousness of cardiovascular disease. Those standards become harder to maintain when payment cuts arrive without a realistic assessment of practice costs.

My appeal to lawmakers is straightforward: preserve a Medicare reimbursement structure that supports high-quality physician services. Listen to the clinicians and patients who can explain how payment policy affects appointment availability, care coordination, and clinical outcomes.

What the fee schedule fails to capture

The current physician payment framework often struggles to measure cognitive and coordination-heavy care. A complex cardiology visit may involve reviewing hospital records, interpreting multiple diagnostic results, reconciling medications, assessing risk, and communicating with primary care clinicians. Much of that work occurs outside the visible face-to-face encounter.

Payment formulas can also lag behind the cost of modern medicine. Cardiologists use advanced imaging, remote monitoring, digital communication, and specialized teams to manage patients more effectively. These tools can improve outcomes and reduce avoidable hospital use, yet the resources required to deploy them are not always reflected in reimbursement.

Broad reductions can be especially damaging when they treat every service as though it carries the same cost and operational burden. A practice that provides intensive evaluation in a medically underserved area does not have the same circumstances as a large organization with extensive administrative support. Policy should recognize variation rather than assuming that every office can absorb another cut.

The stakes for patients and practices

Payment policy outcome	Effect on medical practices	Likely patient impact
Stable, adequate reimbursement	Practices can retain staff and maintain services	More timely appointments and consistent follow-up
Repeated fee schedule reductions	Hiring, equipment, and community outreach may be delayed	Longer waits and fewer local options
Payment that recognizes care coordination	Teams can support complex patients between visits	Better medication management and earlier intervention
Unpredictable annual updates	Practices struggle to plan budgets and staffing	Disruptions in services and reduced continuity
Incentives tied to meaningful quality measures	Investment in prevention and chronic disease management	More coordinated, outcome-focused care

The effects are often greatest for people with the fewest alternatives. Patients in small towns may already have limited access to cardiology specialists. Older adults with transportation barriers may not be able to travel several hours for an appointment. Individuals with disabilities, language barriers, or financial constraints can be pushed further away from care when local practices reduce services.

Practice viability is therefore a public health concern. A cardiology office that closes, stops accepting Medicare, or narrows its scope cannot be replaced quickly. Recruiting specialists takes time, and hospitals may lack the capacity to fill every gap. Preserving existing networks is usually more practical than rebuilding them after access has deteriorated.

Reform should reward value without eroding access

Payment reform should support better outcomes, yet quality initiatives must be designed with care. Measures should reflect conditions physicians can reasonably influence and should account for patient complexity. A practice serving frail patients with advanced disease should not be judged by the same assumptions applied to a healthier population.

Value-based care can work when it gives clinicians usable data, adequate resources, and a fair opportunity to meet patients’ needs. It becomes counterproductive when administrative reporting consumes clinical time or when financial penalties punish practices for serving high-risk populations. The goal should be better care, not the appearance of efficiency achieved through reduced access.

Lawmakers can encourage innovation while protecting the foundation of fee-for-service payment for necessary evaluation and treatment. Hybrid models, care management payments, and targeted incentives may help practices coordinate services. These approaches should supplement essential reimbursement rather than replace it with uncertain revenue streams that leave smaller practices vulnerable.

Principles for a durable Medicare payment system

A responsible approach to physician reimbursement should be guided by practical standards:

• Tie annual updates to the real costs of operating a modern medical practice, including staffing, technology, and regulatory demands.
• Protect access in rural, underserved, and medically fragile communities through targeted support.
• Recognize cognitive work, care coordination, chronic disease management, and time-sensitive follow-up.
• Design quality measures that account for patient complexity and minimize unnecessary administrative burden.
• Include physicians and patients in policy development, implementation, and ongoing evaluation.

These principles are compatible with fiscal responsibility. Preventing complications, improving medication adherence, and managing heart failure earlier can reduce avoidable hospitalizations. However, those benefits depend on practices having the staff and resources to deliver proactive care in the first place.

A strong payment policy should also provide predictability. Practices need to know whether they can retain nurses, expand appointment capacity, replace aging equipment, and participate in community programs. Frequent uncertainty encourages defensive decisions and makes long-term investment difficult.

Patients should have a voice in payment reform

Patients understand access in concrete terms. They know what it means to wait weeks for an appointment, drive across a state for a specialist, or lose the clinician who has managed their condition for years. Their experiences can show policymakers how a technical reimbursement decision affects daily life.

Physicians can describe the operational consequences, while patients can explain the human consequences. Together, these stories create a fuller picture of the stakes. A single account of delayed testing or fragmented follow-up may reveal a pattern that is invisible in a spreadsheet.

Public engagement should remain respectful, accurate, and focused on preserving care. Patients and clinicians can contact representatives, share personal experiences, participate in professional advocacy, and communicate with community organizations. Lawmakers need clear evidence that Medicare payment policy is inseparable from the availability and quality of cardiovascular services.

A commitment lawmakers can act on

Payment reform deserves careful debate, but delay and across-the-board reductions carry their own costs. Every year of unstable reimbursement can weaken practices that patients depend on, especially those already operating with narrow margins. A policy that aims to control spending should measure the downstream effects of reduced access, deferred care, and avoidable complications.

I ask lawmakers to protect Medicare beneficiaries by supporting fair physician payment, realistic annual updates, and reforms that recognize the full work of cardiovascular care. Engage with cardiologists, practice teams, hospitals, and patients before adopting changes that could reshape access for millions of people.

Share your experience with Medicare cardiology care, contact your elected representatives, and support policies that keep skilled cardiovascular professionals available in every community. Access to a cardiologist should depend on clinical need—not on whether a practice can survive an unsustainable payment system.