Cardiology’s migration to the ASC setting continues, but reimbursement is the barrier cited most often by physicians and administrators.
Here are five distinct hurdles:
1. CMS physician pay cuts: The 2025 Medicare Physician Fee Schedule implemented a 2.83% cut to physician reimbursement. Cardiologists say the reductions are increasingly unsustainable given rising costs.
“Unlike any of our other colleagues within the healthcare economic system who always get increases, the physician schedule just continues to get hammered,” Cathleen Biga, MSN, of Cardiovascular Management of Illinois in Woodridge told Becker’s. “And yet our costs are very similar to our hospital colleagues: labor costs, postpandemic supply costs, real estate costs and the complexity of our patients within the outpatient ambulatory setting just continue to escalate.”
2. Private payers lag on outpatient cardiology: While CMS has expanded the ASC-eligible list, commercial payers are slower to adapt. Some procedures approved by Medicare still face denials or pre-authorization delays in the private market, stalling growth for cardiology ASCs.
3. Efficiency not translating into higher revenue: Cardiology ASCs report shorter case times and improved throughput in 2025. However, net revenue per case has declined as contracts fail to keep pace with costs, leaving operators more efficient but not more profitable.
4. New ASC-eligible procedures without aligned payment: CMS’ proposed additions for 2026 include more than 200 cardiovascular procedures, such as electrophysiology ablations and device implants. But inconsistent payer coverage leaves ASCs unsure whether these procedures can be performed sustainably in outpatient settings.
Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, told Becker’s payers are “scrambling” when it comes to pricing and contracts, citing ASCs’ status as a “new space.”
5. Ownership and contracting constraints: ASC ownership models and state certificate-of-need laws continue to shape reimbursement leverage. Facilities without aligned physician-hospital ownership or negotiating strength often struggle to secure contracts that adequately cover high-cost cardiology implants and equipment.
