The Service Line

Note: this Cardiology issue for the week ending August 4, 2026 was published on August 6 after a missed run, and is dated to the week it covers. Sources are cited as of that window.

Cardiology’s 2027 pay headline reads plus 1 percent. The line items underneath read like a cut. CMS released the CY2027 Medicare Physician Fee Schedule proposed rule, and it projects overall cardiovascular reimbursement rising about 1 percent versus 2026. That number absorbs a second straight year of the negative 2.5 percent “efficiency adjustment” and hides steep reductions to specific high-value work: tricuspid valve codes are proposed more than 28 percent below the RUC recommendation, coronary intravascular ultrasound down 20 to 25 percent, and left atrial appendage closure work RVUs down 10 percent. The conversion factor for clinicians outside an advanced APM would fall from $33.4009 to $32.8409. The ACC is pressing to kill the efficiency adjustment through the Efficiency Adjustment Delay Act (H.R. 7520). Confidence: High on the proposed values; the net effect on any single practice depends on service mix. ACC 2027 PFS summary.

Reimbursement

The proposed 50 percent same-day E/M cut is the one every office cardiologist should model now. The 2027 proposed rule would halve the evaluation and management payment when it is billed on the same day as a 0, 10, or 90 day global procedure by the same physician or practice. That is a direct hit to the two workflows that define office cardiology economics: the visit-plus-device-check and the visit-plus-echo. In the same rule, CMS proposes four new G codes to replace the 17 existing remote physiologic and therapeutic monitoring codes, reshaping the specialty’s fastest-growing recurring-revenue line. Confidence: High. ACC 2027 PFS summary.

On the facility side, cardiac procedures keep their inpatient-only protection one more year, but the clock is set. The companion CY2027 Hospital Outpatient and Ambulatory Surgical Center proposed rule, released July 2, again defers cardiovascular inpatient-only list removals to 2028, citing clinical complexity, while removing about half of the remaining inpatient-only services in other specialties. For cardiology this is a reprieve, not a reversal: the site-of-service migration that already made cardiac ablation ASC-payable is scheduled to reach more cardiac codes next cycle. The comment deadline is August 31, 2026. Confidence: High. CMS CY2027 OPPS/ASC fact sheet.

Enforcement

A vascular practice paid more than $6.73 million to settle claims of unnecessary artery interventions, and the theory behind it is the one every peripheral program should audit against. The Department of Justice resolved False Claims Act allegations that a vascular physician and practice performed medically unnecessary dialysis-access interventions and peripheral artery disease procedures, including angioplasty, stenting, and atherectomy, and repeated them every few days or weeks without clinical benefit. This is the exact pattern that makes peripheral vascular the specialty’s number-one enforcement magnet. The operator screen has not changed: atherectomy-per-claudicant ratios and repeat-intervention intervals are what a government data pull flags first. Confidence: High on the settlement; the audit takeaway is our analysis. DOJ settlement release.

Who’s Buying

Roughly half of cardiology practices are now private-equity owned, and the buyers have not slowed. MedAxiom’s most recent compensation survey put PE ownership of cardiology groups at about 50 percent, with integrated median cardiologist compensation crossing $700,000 against $588,479 in private practice, the widest gap in years. The largest platforms, Cardiovascular Associates of America (Webster Equity) and US Heart and Vascular (Ares), continue to add groups, with Florida a particular density point. A fourth vector sits alongside PE, hospital employment, and MSO alignment: Humana’s value-based cardiology partnerships, which now extend beyond the roll-ups to several independent-friendly enablers. For an independent group, the practical question is no longer whether to align but against which of the four bids. Confidence: High on the ownership share and comp figures; Medium on live 2026 deal pace, which moves weekly. MedAxiom survey coverage · Humana value-based cardiology.

Clinical Policy

CMS’s proposed TAVR coverage rewrite protects incumbents and opens the door for new heart-valve programs. The proposed national coverage determination for transcatheter aortic valve replacement would keep procedural volume expectations for established programs but lower the bar for new centers, replacing rigid operator-volume proxies with infrastructure and quality-improvement standards. It would also end Coverage with Evidence Development for symptomatic severe aortic stenosis while extending it to asymptomatic severe disease. For hospital structural-heart lines this shifts the competitive map: fewer barriers to a rival program opening nearby. A final decision is expected around September 13, 2026. Confidence: High on the proposal; the decision is not final. TCTMD coverage analysis · ACC on the proposed NCD.

The Operator Metric

Track the facility-fee spread on your highest-volume implant. For an ICD it ranged more than five-fold across insurers. A cross-sectional study in JAMA Network Open of 32 cardiology services across four major insurers found the facility fee for an implantable cardioverter-defibrillator ranged from $6,674 at Aetna to $36,269 at UnitedHealthcare, a greater than five-fold spread for the same procedure. The number matters for two reasons: it is the evidence base site-neutral-payment advocates are citing, and it tells an aligned or employed cardiologist exactly how much of their case’s economics lives in the facility fee rather than the professional fee. Watch it as the single figure that connects your site-of-service strategy to the payment-reform risk building behind it. Confidence: High on the published figures. JAMA Network Open study.