Half of cardiologists expect the 2026 Medicare physician fee schedule to hurt them financially, according to Medscape’s “Issues in Cardiology Report 2026,” published Nov. 9.
Of the 152 U.S. cardiologists surveyed between March 3 and April 16, 43% anticipated a somewhat negative financial effect and 7% a very negative one. Just 10% expected the rule to help, while 40% were neutral.
The fee schedule, which took effect Jan. 1, raised the base dollar amount used to calculate payments by 3.3%, or 3.8% for qualifying participants in some payment models. But changes to how individual services are valued mean cardiologists’ actual payments depend on which services they provide and where they practice, and the long-term trend has not favored physicians: Medicare reimbursement has lagged practice costs and inflation for years.
“It shapes decisions about which insurers a practice accepts and how much it relies on commercially insured patients, who bring in higher negotiated prices, to cross-subsidize Medicare patients,” Jane Zhu, MD, a health services researcher and associate professor of medicine at Portland-based Oregon Health & Science University, told Medscape.
“So far, most physicians still accept Medicare patients,” Dr. Zhu continued. “The more likely access effects are that practices limit new Medicare patients in some specialties or areas and that financial pressure pushes independent practices to sell or for physicians to leave for concierge or other models.”
In cardiology, the buyer is often private equity. Nearly 50% of private cardiology practices were part of a private equity portfolio, according to MedAxiom’s 2024 provider compensation and production survey, and private equity firms made more than 340 acquisitions of cardiology clinics between 2013 and 2023, most of them from 2021 to 2023.
Cardiologists are not convinced the trend serves patients. Fifty-nine percent of respondents said private equity investment decreases the quality of patient care, while 34% said it has no effect and 7% said it improves quality. Forty-five percent said it decreases patient care spending.
“The signals of poorer quality are much more alarming for hospitals and nursing homes than for physician practices, where the picture is less clear,” Dr. Zhu said. “One reason is that it’s generally harder to link outpatient care to patient outcomes.”
The pressure shows up in how cardiologists describe their own work. Asked to name their biggest challenges, one respondent pointed to “reimbursements that are not keeping up with practice expenses.” Another cited “maintaining the quality of care and patient trust amid demands of productivity targets and time spent keeping up with charts and labs/messages.” A 32-year-old cardiologist in California listed “takeover of imaging by AI and pressure to see more patients and promote more procedures.”
Still, most respondents said that last pressure has not reached them. Only 16% reported feeling pressure to add procedures or techniques, such as Watchman or pulsed-field ablation, for marketing advantage, while 70% said they had not.
“Cardiology is a specialty where this deserves close attention, because procedures are increasingly done in office-based settings with favorable reimbursement,” Dr. Zhu said. “The hard part is telling whether increases in services are because they are newly accessible — which is a good thing — vs inappropriate care driven by revenue, which is a bad thing.”
Efficiency is where cardiologists gave private equity the most credit. Thirty-one percent said private equity increases practice efficiency, roughly matching the 32% who said it decreases efficiency, with 37% reporting no effect. Rishi Wadhera, MD, director of the Smith Institute for Evidence, Innovation, and Policy and associate professor of medicine at Boston-based Harvard Medical School, called efficiency “private equity’s strongest argument.”
“But efficiency is not the same as value,” Dr. Wadhera told Medscape. “A shorter visit or an earlier discharge looks good on a balance sheet. Whether it was good for the patient shows up later.”
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