For some independent cardiology practices, financial and operational stability may feel like a moving target as reimbursement policies and reporting requirements continue to shift.
Larry Sobal, CEO of Heart and Vascular Institute of Wisconsin in Appleton joined Becker’s to discuss the administrative and financial complications he is identifying and navigating within his independent cardiology practice in 2026.
Editor’s note: This response has been lightly edited for clarity and length:
Q: What area of your practice’s financial management do you feel you have the least visibility on? What sort of tools, regulatory changes or processes do you believe might improve that visibility?
LS: As an independent cardiology practice, we have a high percentage of Medicare, Medicare Advantage and Medicare Supplemental patients, we suffer the whims of CMS every year in terms of [work relative value unit] adjustments, [Center for Medicare and Medicaid Innovation] programs and overall physician fee schedule changes. The overall strategy of CMS is not clear, other than to systematically drive independent physicians into employment by hospitals or private equity.
Q: What specific administrative processes are slowing you or your team down the most right now? How are you addressing those concerns?
LS: Prior authorizations have become a barrier to timely care. We are never quite sure how long the prior auth will take and whether, despite a prior auth, or if a peer-to-peer will be necessary. We are constantly adjusting our processes to be sure that we stay on top of each patient’s prior-auth status and whether a test or procedure can proceed.
Q: What’s the best thing you’ve done to streamline operations at your practice in the last year? LS: It’s currently a work in process, but we are replacing our stand-alone EHR with Epic from one of the local health systems. Almost all of the local medical community is on some form of Epic and the challenges of being on a separate system creates a lot of extra work in terms of communication, chart prep, etc. After a few cancelled go-live dates when the health system wasn’t ready, we seem to be heading toward a go-live next month.
