How the American College of Cardiology defends heart care access

When cardiology reimbursement rates are slashed, the consequences rarely stay confined to billing departments. Patients wait longer for appointments, smaller practices absorb losses they cannot recover, and rural communities often lose the specialists they depend on. The American College of Cardiology has positioned itself as the leading voice opposing these cuts, mobilising tens of thousands of cardiovascular professionals across the United States to press lawmakers and regulators for fairer treatment.

For clinicians and patient advocates watching from Sydney, Melbourne, or Perth, the College's playbook offers a window into how a professional medical society can shape national health policy. Australia's Medicare Benefits Schedule operates under different rules, but many of the underlying tensions, including workforce shortages, regional access gaps, and pressure on private practice viability, mirror those that drove American cardiologists into the streets of Washington.

Origins and mission of the American College of Cardiology

Founded in 1949, the American College of Cardiology began as a small professional society for cardiovascular specialists. Today it represents more than 56,000 members across the United States and over 130 countries, including a growing contingent of Australian fellows based in Brisbane, Adelaide, and beyond. Its core mission centres on transforming cardiovascular care and improving heart health, which in practice means translating clinical expertise into policy positions.

Over seven decades, the College has built institutional capacity that few other specialty societies can match. It publishes the Journal of the American College of Cardiology, runs the National Cardiovascular Data Registry, and administers board certification pathways recognised worldwide. This infrastructure gives the organisation weight when it testifies before the US Congress or files amicus briefs in federal court.

Crucially, the ACC operates as more than a clinical body. Its advocacy arm tracks every regulatory change that touches cardiology practice, from Medicare reimbursement formulas to telehealth payment rules. When the Centers for Medicare and Medicaid Services proposed adjustments to the physician fee schedule, the College responded within days with detailed technical comments and member mobilisation campaigns.

Coalition building with patient and physician groups

Fighting fee schedule cuts alone rarely works. The College has learned this through repeated campaigns, including the 2023 launch of the "Cardiology is Essential" initiative, which united subspecialty societies, hospital systems, and patient advocacy organisations under a shared message. The Campaign for Patient Access emerged from this coalition as a dedicated public-facing effort to humanise the policy debate.

The Campaign's strategy rests on three pillars: collecting patient stories, equipping practices with tools to contact legislators, and generating media coverage in regional outlets from Houston to Honolulu. Australian observers familiar with the Heart Foundation's Heart Week campaigns will recognise the approach, even though the regulatory targets differ.

Advocacy feature	American College of Cardiology (US)	Cardiac Society of Australia and New Zealand
Primary policy target	Medicare physician fee schedule	Medicare Benefits Schedule reviews
Member base	~56,000 cardiovascular professionals	~2,500 cardiology clinicians
Public campaign vehicle	Campaign for Patient Access	Heart Foundation partnerships
Data registries	National Cardiovascular Data Registry	ANZSCTS cardiac surgery database
Annual scientific meeting	ACC Scientific Sessions	CSANZ Annual Scientific Meeting
Legislative engagement	Direct lobbying in Washington	Submissions to parliamentary committees

This side-by-side comparison illustrates how professional societies adapt similar advocacy frameworks to vastly different health systems. Australians reading the table may notice that our cardiology bodies rely more heavily on indirect influence through submissions to the Department of Health and Aged Care, rather than the direct congressional lobbying that defines the ACC strategy.

The 2021-2024 Medicare fee schedule battle

The conflict that propelled the Campaign for Patient Access into public view began with a routine regulatory process. The Medicare physician fee schedule is updated annually, and since 2021 the Centers for Medicare and Medicaid Services have proposed conversion factor reductions that would have collectively trimmed cardiology payments by several percentage points. The College calculated that a typical cardiovascular practice could lose hundreds of thousands of dollars annually under some scenarios.

The response combined technical analysis with political pressure. Actuarial studies showed reduced patient access in rural areas, op-eds ran in outlets serving states with large cardiology workforces, and "white coat Wednesday" events sent cardiologists into congressional offices in person. The Campaign for Patient Access website became the central hub, collecting nearly 10,000 letters from patients and clinicians to members of Congress.

By 2024, the College had secured partial victories. Congress passed targeted legislation softening the conversion factor cut, and some cardiology-specific codes received favourable adjustments in the final fee schedule. Yet the structural tension between budget neutrality requirements and specialty reimbursement remains unresolved, which is why the Campaign continues to operate rather than wind down.

Legal challenges and strategic litigation

Beyond lobbying, the College has explored judicial pathways when administrative remedies fail. It joined multi-society challenges to certain CMS rules, arguing that the agency overstepped its statutory authority in implementing payment reforms without adequate notice and comment. Federal courts have not always sided with physicians, but the threat of litigation has occasionally pushed regulators toward negotiated settlements.

This litigation strategy reflects a broader shift in medical society advocacy. Where once professional associations focused exclusively on Capitol Hill, today's groups treat the courts as an equally important venue. The Australian Medical Association has taken a similar path through its involvement in cases before the Federal Court of Australia, particularly around regulatory decisions by the Therapeutic Goods Administration.

The College's legal work also covers scope-of-practice disputes, surprise billing implementation, and site-of-service payment differentials. Each of these fights carries implications for how cardiovascular care is delivered, whether in a hospital outpatient department, an ambulatory surgery centre, or a private office. By engaging early in rulemaking and remaining prepared to litigate, the College has established itself as a formidable counterweight to federal agencies.

Lessons for Australian cardiology advocacy

Australia has not faced the same scale of fee schedule reductions that triggered American mobilisation, but the underlying pressures are familiar. The Medicare Benefits Schedule Review, ongoing reforms to private health insurance arrangements, and workforce distribution challenges all create conditions where cardiologists and patients can suddenly find their access narrowed. The experiences of the American College of Cardiology offer a template for proactive rather than reactive advocacy.

Three practical lessons stand out for Australian practitioners. First, data registries provide the evidence base that turns anecdotes into persuasive policy arguments; Australia's existing clinical databases could be expanded to serve a similar function. Second, coalition building amplifies voice; the Cardiac Society of Australia and New Zealand, the Heart Foundation, and the AMA speaking in unison would carry far more weight than any single organisation. Third, patient stories humanise technical debates, and Australians affected by cardiology access delays in regional New South Wales or Western Australia have powerful testimonies to share.

The Campaign for Patient Access demonstrates that sustained advocacy requires infrastructure, funding, and patience. It also shows that cardiovascular professionals can speak with one voice when the stakes are clear. For Australian cardiologists watching their American colleagues, the message is that organised, evidence-based, and patient-centred advocacy can shift policy outcomes, even against entrenched fiscal headwinds.

Readers concerned about cardiology access in their own communities can support these efforts by adding their voice to ongoing campaigns, sharing their experiences with local representatives, and following professional society updates to stay informed about emerging policy threats.