cardiologists are testifying before Congress about the fee schedule

Cardiologists from across the United States are packing their briefcases and booking flights to Washington, not for conferences or sightseeing, but to sit before Congressional committees and explain, in plain terms, what proposed Medicare physician fee schedule cuts would mean for the patients they treat. The testimony has become a regular feature on Capitol Hill calendars, with specialty societies lining up alongside individual practitioners to defend reimbursement rates that many warn are already too low to sustain independent cardiology practices. For clinicians watching from Sydney, Melbourne, or Perth, the story carries familiar echoes of debates that have played out around the Medicare Benefits Schedule.

The American College of Cardiology and its affiliated Campaign for Patient Access argue that the issue is not abstract budget politics but a direct threat to timely cardiac care. When reimbursement falls below the actual cost of delivering services, practices consolidate, retire, or stop accepting new Medicare patients altogether. Australians understand this calculus through their own experience with bulk billing rates, specialist waiting lists, and the steady erosion of fully rebated services. The fight on Capitol Hill is, in many ways, a preview of pressures that specialists in every advanced health system are bracing for.

The stakes behind the fee schedule fight

The Medicare physician fee schedule determines how much the federal government pays clinicians for every covered service, from a routine consultation to a complex ablation procedure. Cardiovascular work tends to fall disproportionately under the schedule because cardiology sits at the intersection of cognitive care and procedural work, with echocardiograms, stress tests, catheterisations, and device implants each carrying their own billing codes. When the schedule is trimmed, even by a few percentage points, the cumulative effect on a cardiology practice's revenue can run into six figures a year.

Cardiologists testifying before Congress have framed the cuts as a structural undervaluation of their specialty. Conversion factor adjustments, budget neutrality rules, and periodic updates from the Centers for Medicare and Medicaid Services tend to favour primary care in dollar terms while leaving specialty rates stagnant or declining in real dollars. Practitioners describe being asked to deliver more sophisticated care, with more technology and higher patient complexity, for the same or lower payment than a decade earlier. The American College of Cardiology has invested heavily in making those numbers legible to lawmakers who rarely see the inside of a cardiac catheter lab.

How cuts reshape patient access in real clinics

The chain reaction begins when a practice receives notice that its largest payer is cutting reimbursement. Administrators first defer equipment purchases, then trim staff hours, and eventually stop taking new Medicare patients. In rural counties across the United States, cardiology groups have already closed satellite clinics because the volume simply cannot cover overhead. Patients who once drove twenty minutes for a stress test now drive ninety, or wait months for a hospital-based appointment.

Cardiologists describing these scenarios in Congressional testimony use specifics rather than generalities. They talk about the nurse practitioner who left for a hospital system because the practice could no longer match her salary. They mention the Holter monitor that sits in a cupboard because the reimbursement no longer covers the technician's time to fit and interpret it. They name towns where the only cardiology presence was a solo practitioner who retired and was not replaced. The Campaign for Patient Access collects these accounts because policymakers respond to the concrete in ways they do not respond to aggregate statistics.

Comparing reimbursement systems side by side

Feature	United States (Medicare fee schedule)	Australia (Medicare Benefits Schedule)	United Kingdom (NHS tariff)
Setting body	Centers for Medicare and Medicaid Services	Department of Health and Aged Care	NHS England
Update cadence	Annual rulemaking	Periodic MBS reviews	Multi-year tariff cycles
Bulk or default billing	Rare for specialists	Common for GPs, limited for specialists	Universal at point of use
Specialist leverage	Strong via specialty societies and PACs	Moderate via AMA and RACP	Limited, central negotiation
Patient cost exposure	Co-pays, deductibles, supplemental insurance	Out-of-pocket gaps, private health cover	Minimal at point of use
Recent pressure	Conversion factor reductions, budget neutrality	Indexation freeze, rebate stagnation	Contract disputes, industrial action

The table is not a tidy scoreboard. Each system has its own pressure points, and each produces different incentives for where cardiologists locate, what they offer, and how quickly patients are seen. The pattern that unites them is the slow squeeze on specialist reimbursement relative to operating costs.

Why Capitol Hill hearings matter for specialty care

Congressional hearings are not legislation, but they shape the political weather in which legislation moves. When cardiologists sit in the witness chair and explain how a three percent cut translates into closed clinics and longer wait times, they are building a record that committee staff, reporters, and other members of Congress can draw on when draft bills come up for markup. They are also signalling to the executive branch that the medical community is organised and informed, which can influence how aggressively regulators pursue cuts in the first place.

The Campaign for Patient Access has leaned into this reality. Rather than relying on a single lobbying channel, the campaign combines grassroots patient stories, direct physician testimony, legal challenges, and coordinated media work to keep the fee schedule on the political agenda. That breadth is deliberate: a single approach can be ignored, but a chorus is harder to dismiss. Practitioners recognise this from their own experience with hospital politics, where proposals rarely die from one objection but sometimes die from a coalition of them.

Australian cardiologists watch with growing concern

Australian specialists have their own version of the fee schedule debate playing out through the Medicare Benefits Schedule. The MBS review process, ongoing for years, has trimmed rebates for some cardiology procedures while leaving others untouched, and the indexation freeze through much of the 2010s eroded the real value of specialist rebates by roughly a third. Cardiologists at Royal Prince Alfred, The Alfred, and Royal Brisbane and Women's Hospital have watched colleagues in private practice stop bulk billing new patients or close rooms in regional centres such as Tamworth, Cairns, and Warrnambool.

The Royal Australasian College of Physicians and the Australian Medical Association have raised similar concerns to those now being aired in Washington. The argument is straightforward: when the public rebate no longer covers the cost of delivering care, the gap falls on patients through out-of-pocket fees, or on clinicians through subsidised care they can no longer afford to provide. American cardiologists describing this dynamic in Congressional hearings are, in many ways, giving voice to a pattern that Australian clinicians already recognise. State branches of the AMA in New South Wales, Victoria, and Queensland have all publicly criticised successive federal budgets for underfunding specialist consultations.

Inside the campaign's multi-pronged approach

The Campaign for Patient Access has structured its work to attack the fee schedule problem from several angles at once, recognising that any single tactic invites a single counter-move. Lawyers file challenges to specific rule changes. Lobbyists brief members of Congress on the budget consequences of clinic closures. Communications staff place op-eds and arrange interviews so that the issue stays visible outside specialist circles. Patients and physicians share their stories through the campaign's online portal, putting a human face on a budget line item.

The reasons for this breadth are explained in detail in the campaign's own piece on why the Campaign for Patient Access uses a multi pronged strategy. The short version is that fee schedule policy is shaped by administrative rulemaking, legislative appropriations, judicial review, and public opinion all at once. A campaign that engages only one of those levers leaves the other three free to work against it. Medical specialty societies around the world have borrowed the same playbook, including the Cardiac Society of Australia and New Zealand, which uses parliamentary submissions, clinical guidelines, and media engagement in parallel.

Voices from the exam room and the hearing room

What gives the Congressional testimony its weight is the contrast between the rooms the cardiologists come from and the room they enter. An electrophysiologist who spends Tuesday implanting pacemakers and Thursday explaining ablation options to anxious patients is suddenly speaking into a microphone, citing cost figures and procedure volumes, hoping to translate lived clinical experience into legislative language. Colleagues back home watch the hearings online, sometimes sharing clips in WhatsApp groups between clinic sessions or in the tea room at the end of a long list.

The campaign encourages that kind of participation because it has learned that lawmakers remember faces and stories long after they forget statistics. A patient describing a two-month wait for an echocardiogram, or a practice manager describing the closure of a satellite office in a town of nine thousand, sits in the memory of a Congressional aide in a way that an aggregate table does not. Australians watching from the outside can borrow the same playbook when engaging with their own parliamentary inquiries into Medicare funding, by submitting individual accounts rather than relying on institutional submissions alone.

Anyone concerned about access to cardiac care, whether in the United States or in Australia, can add their voice to the campaign, share a story through its online portal, or contact their elected representative to underline why specialist reimbursement deserves more than a footnote in a budget reconciliation bill. The cardiologists heading to Washington are counting on patients and colleagues across the Pacific to do the same in their own legislatures, because the arithmetic of fee schedules does not respect national borders.