The Service Line

Five of cardiology and cardiac surgery’s biggest specialty societies told CMS this week that stripping the surgeon out of the room for Transcatheter Aortic Valve Replacement (TAVR) approvals goes too far, teeing up a fight before the government’s September ruling. The American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), Heart Failure Society of America (HFSA), Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Thoracic Surgeons (STS) filed joint comments ahead of the July 15, 2026 close of the public comment period on the Centers for Medicare and Medicaid Services (CMS) proposed national coverage determination (NCD) reconsideration for TAVR, arguing CMS should keep the current requirement that an interventional cardiologist and a cardiac surgeon jointly evaluate every patient rather than allow a single operator to decide. The societies also want CMS to preserve Coverage with Evidence Development (CED) for higher-risk populations, including bicuspid aortic valve anatomy and new valve types, even as the proposal drops CED for standard symptomatic severe aortic stenosis. CMS’s final decision memo is expected by September 13, 2026, and hospitals that have struggled to hit legacy procedure-volume minimums have the most to gain if the proposal survives to a final rule. Confidence: High on the societies’ positions and dates; Medium on whether CMS revises the volume-requirement language versus the operator mandate in the final memo. Sources: SCAI Participates in Multispecialty Comments on National Coverage Analysis Request for TAVR, Society for Cardiovascular Angiography and Interventions, STS and ACC Support National Coverage Analysis for Transcatheter Aortic Valve Replacement, Society of Thoracic Surgeons, NCA - Transcatheter Aortic Valve Replacement (TAVR) (CAG-00430R2), CMS.

Reimbursement

Up to one in five cardiologists CMS has slated for its mandatory Medicare risk model may not actually belong there, according to the American College of Cardiology’s (ACC) own analysis of the agency’s specialty coding. ACC found that up to 20 percent of physicians CMS selected for the Ambulatory Specialty Model (ASM), the mandatory five-year program forcing outpatient heart-failure cardiologists into two-sided financial risk starting January 1, 2027 with payment swings of negative 9 percent to positive 9 percent on Part B claims, may be misclassified under the cardiovascular disease specialty designation CMS used to build its participant list. ACC is pressing CMS to correct the classification before the model locks in its roughly 8,600-physician participant roster, since a miscoded practice could be pulled into mandatory risk it was never supposed to carry, while genuinely eligible general cardiologists who are misclassified elsewhere could be missed entirely. Any general cardiology or heart-failure group that has not independently checked its own CMS specialty classification this summer should do so before the model’s regions and rosters finalize. Confidence: Medium, ACC’s own coding analysis has not been independently replicated. Source: Heart of Health Policy: ACC Urges Changes as Ambulatory Specialty Model Approaches 2027 Launch, American College of Cardiology.

Enforcement

A Texas cardiologist who was the only doctor reviewing tens of thousands of student-athlete heart scans allegedly signed off on 63 of one teenager’s results in about 11 seconds, and the teenager died of cardiac arrest 24 days later. The Department of Justice (DOJ) charged Dr. Jason Finkelstein, 53, of Fort Worth, Texas, with conspiracy to commit health care fraud, wire fraud and health care fraud as part of its 2026 National Health Care Fraud Takedown, announced June 23, 2026, alleging Finkelstein used two companies he owned to submit approximately 89 million dollars in false and fraudulent claims for cardiovascular tests performed on student athletes at school campuses nationwide, of which insurers paid roughly 13.1 million dollars, while falsely representing that he had clinically reviewed each test when he had not. The takedown, DOJ’s largest coordinated health care fraud action to date at more than 6.5 billion dollars in alleged fraud and 455 defendants charged including 90 licensed medical professionals, used data analytics to flag the scheme before more claims paid out. Any cardiology group running high-volume screening programs, in schools, workplaces or pop-up clinics, should treat sign-off turnaround time per study as an internal audit metric now, not after a subpoena. Confidence: High. Source: National Health Care Fraud Takedown Results in 455 Defendants Charged in Connection with Over $6.5 Billion in Alleged Fraud, U.S. Department of Justice.

Who’s Buying

The cardiologist who runs the specialty’s own practice-benchmarking arm is publicly pushing back on the narrative that private equity is about to own cardiology outright, even as outside dealmakers say the specialty stays one of the two hottest targets in healthcare for the rest of 2026. MedAxiom president and CEO Jerry Blackwell, speaking around the American College of Cardiology’s (ACC) 2026 annual meeting, said private equity’s actual footprint in cardiology remains relatively small and is unlikely to become the dominant ownership model, arguing that concerns about private equity have outpaced its real market presence even as MedAxiom’s own survey data show close to half of private-practice cardiology groups now under some private equity ownership. PricewaterhouseCoopers’ (PwC) mid-year 2026 health industries deals outlook separately named cardiovascular services one of the two most sought-after physician specialties heading into the second half of 2026, alongside continued private equity dry powder and interest rate reductions supporting further deal activity. For a group weighing a recapitalization offer, the read is that deal flow is not slowing, but the “PE already owns cardiology” framing used to justify aggressive terms may be overstated. Confidence: Medium, Blackwell’s comments are directional and MedAxiom’s ownership survey is self-reported; High on PwC’s outlook language. Sources: Jerry Blackwell explains why private equity is courting cardiology, Cardiovascular Business, Medtech: US Deals 2026 midyear outlook, PwC.

Clinical Policy

Cardiology’s governing societies just rewrote what counts as heart failure, and the change reaches directly into which patients trigger the specialty’s new mandatory Medicare risk model. The American Heart Association (AHA), ACC, European Society of Cardiology (ESC) and World Heart Federation (WHF), with the HFSA and other societies, published the Second Universal Definition of Heart Failure, moving away from rigid left ventricular ejection fraction (LVEF) cutoffs toward three clinically actionable categories, heart failure with reduced, improved or preserved ejection fraction, with the lower limit of normal LVEF set at approximately 53 percent for women and 52 percent for men. The update accounts for variation by sex, age, ethnicity and imaging modality that the old fixed cutoffs obscured, which changes which patients qualify for guideline-directed therapies and, by extension, which patients and practices fall inside the ASM’s outpatient heart-failure population once CMS operationalizes the new criteria. Practices should expect echo reporting templates and HF registry criteria to shift behind this definition over the next reporting cycle. Confidence: High on the definition’s substance and authorship; Medium on how quickly CMS and ASM operations adopt it. Source: AHA/ACC/ESC/WHF Expert Consensus Document: Second Universal Definition of Heart Failure (2026), Circulation.

The Operator Metric

The number to track this week: a more than fivefold gap in what insurers pay for the exact same cardiac device implant, depending only on which payer’s contract is in the room. A study published online July 16, 2026 in JAMA Network Open examined commercial facility-fee payments across four major national insurers for 32 common cardiology services and found median facility fees for implantable cardioverter-defibrillator (ICD) insertion ranged from 6,674 dollars under Aetna to 36,269 dollars under UnitedHealthcare, with Blue Cross Blue Shield running as high as 1.31 times the market average and Aetna as low as 0.39 times it for electrophysiology procedures. The study’s authors said the pricing data should inform site-neutral payment policy and efforts to address anticompetitive facility contracting, since the variation traces to payer-facility negotiating leverage rather than any difference in the underlying procedure. Any group negotiating a hospital employment, co-management or ASC/office-based lab joint-venture deal this week should pull its own per-payer facility-fee schedule before assuming its current contract reflects market rate. Confidence: High, peer-reviewed cross-sectional study. Sources: Commercial Price Variation for Common Cardiovascular Services Across Major US Insurers, JAMA Network Open, Facility fees major source of variation in cardiology services pricing by insurer, Healio.