Webinar: How to Publish in JASE & Plans from the New EIC

January 26, 2023, 6:00 – 7:00 PM ET

Make plans to attend ASE’s next webinar on Thursday, January 26, 2023, 6:00 – 7:00 PM ET. Learn about what the future holds for JASE under the direction of its fourth Editor-in-Chief Patricia A. Pellikka, MD, FASE. The presentation is pre-recorded with a live Q&A session to follow. This webinar does not offer CME, and both members and nonmembers can attend for free.

Register now!

Introducing Critical Care eCASE Series

Register Now for the Live Q&A Session on CASE 1: January 23, 2023, 5:00 PM ET

The new Critical Care eCASE Series is a blended online learning activity that will cover three Critical Care eCASES through March 2023. Each case will focus on application of echocardiography and general point of care ultrasound (POCUS), to help diagnose a critically ill patient’s physiologic derangement and how serial examinations help with therapeutic management.

The first Q&A Live Session on CASE 1 will be held online on January 23 at 5:00 PM ET. It will focus on a patient with large pericardial effusion but no echocardiographic evidence of tamponade. The patient, however, had signs and symptoms of tamponade and also had renal failure and pre-existing pulmonary hypertension. The case will discuss the management of this patient.

Cardiologists, interventionalists, emergency medicine physicians, and cardiovascular sonographers are encouraged to review case presentations and participate in the three upcoming Critical Care eCASE Series Q&A live sessions. The series is free for ASE Members and $45 for nonmembers. Register in the ASE Learning Hub. Earn up to 4.5 AMA PRA Category 1 Credits (pending approval) for participation in the entire three-part series.

January CASE – Special Issue on Echo in Valvular Heart Disease

The first issue in 2023 of CASE, ASE’s open access case reports journal, is now available; this Special Issue on Echo in Valvular Heart Disease and Interventional Echo is a companion to the January JASE focus issue. In one report, Tanuka Datta, MD and colleagues from Thomas Jefferson University, Philadelphia, Pennsylvania, present two examples of the important role of interventional echocardiography during PFO closures. CASE Editor-in-Chief Dr. Vince Sorrell commented, “This CASE report reiterates the symbiotic relationship that is necessary between the proceduralist and the imaging specialist for successful clinical outcomes. In both cases, the patient had suffered a stroke, and the PFO was associated with a large shunt or an atrial septal aneurysm. The authors provide Journal readers with an excellent overview of PFO morphology and offer a standardized terminology for PFO dimensions that should improve the ability to communicate and enhance the likelihood for more optimal device selection. The CASE includes exceptional, high quality still and moving images as well as an educational table and graphic. If you have ever performed a TEE and found a PFO, you will find this report worth reading (and then keeping in your CASE file for future reference).”

This issue also includes three Echo Valvular Heart Disease reports illustrating various clinical presentations of quadricuspid aortic valve disease and a rare congenital case of unileaflet mitral valve. There are also four articles in the Interventional Echocardiography section demonstrating the value of TEE guidance in multiple scenarios and two novel transcatheter procedures. Dr. Sorrell’s editorial, “Best CASE Scenario,” provides an update on the overall state of CASE, highlighting the continued growth of the Journal, a focus on engaging sonographers, and other developments over the past year.

Also, check out the newest Sonographer Sound-Off (SSO) on the CASE Homepage, an interactive feature that provides an opportunity for sonographers to share tips and tricks they have learned in everyday practice. Congratulations to María Elena Sánchez, MD, Trinidad Mitre Institute, Roxana Ratto, MD, Cardiology Offices Doctor T. Padilla, and Mariana Corneli, MD, Institute of Cardiology La Plata, all in Buenos Aires, Argentina, for serving in the role of Sonographer and supplying the images and text for this SSO.

We hope this issue starts your new year off with a bang!

Announcing ASE’s 2023 Award Winners

ASE is proud to support the cardiovascular ultrasound community through recognition of outstanding service, research, and training. We are happy to announce and congratulate the ASE 2023 Award Winners! These recipients will be recognized during the 34th Annual ASE Scientific Sessions in National Harbor, Maryland, June 23-26, 2023. These awards are peer-reviewed and were selected by the Awards Committee, chaired by Sherif Nagueh, MD, FASE.

Rebecca Hahn, MD, FASE – Columbia University Medical Center, New York, NY


William Zoghbi, MD, FASE – Houston Methodist Hospital, Houston, TX


Cynthia Taub, MD, FASE – Dartmouth Hitchcock Medical Center, Lebanon, NH


Richard Palma, ACS, RCCS, FACVP, FASE – Duke University Medical Center, Durham, NC


Peter Frommelt, MD, FASE – Children’s Wisconsin/Medical College of Wisconsin, Milwaukee, WI


Madhav Swaminathan, MD, MMCi, FASE – Duke University Medical Center, Durham, NC


Allan Klein, MD, FASE – Cleveland Clinic, Cleveland, OH

Contribute to Echo Magazine

Celebrating One Year as a Monthly Publication

This month marks one year since ASE’s Echo magazine increased its publishing frequency from once or twice a year to monthly. In the past year, we’ve been able to more frequently share communications from the ASE President, ASE Councils and Specialty Interest Groups, and ASE members who have contributed interesting articles or images related to cardiovascular ultrasound that are not research articles/images.

There is so much to share about our vital and essential field, and this year, we once again invite all ASE members to consider writing and submitting an article to share with your fellow members and peers. The submission deadline is the 15th of each month, and you can review the guidelines on formatting, word length, and other general information on ASE’s website. Contact Echo@ASEcho.org with questions about this online, open access publication.

Thank you to all who have submitted articles, and we can’t wait to receive your submissions in 2023!

Act Now to Save on SOTA Registration

There are only a few days left to save on registration for the 35th Annual State-of-the-Art Echocardiography™. Register by Tuesday, January 17, 2023, and save $100!

Join outstanding faculty in sunny Scottsdale, Arizona, and learn the latest on structural heart disease, myocardial and pericardial disease, coronary artery disease, interventional echocardiography, and more! Act fast if you’re interested in participating in the optional preconference Learning Lab (separate fee required). Limited registration spots remain for these intimate sessions!

A total of 31.75 AMA PRA Category 1 credits(pending approval) will be offered for the preconference Learning Lab (15 credits) and main course (16.75 credits). In addition to offering CME credits, this activity has been developed and registered with ACCME to provide MOC, MOC Part 2, and MOCA 2.0 credits in alignment with AMA PRA Category 1 Credit™.

Finally, after registering, we encourage you to book your hotel reservation with the Westin Kierland as soon as possible. The hotel room block will be held until Monday, January 16, 2023, but we expect it will sell out soon. This is a beautiful property offering golf, tennis, pools, and a spa onsite.

ASE Releases Updated Rheumatic Heart Disease Guideline


Contact: Angie Porter

American Society of Echocardiography Releases Updated Rheumatic Heart Disease Guideline

The guideline focuses on the use of echocardiography in the evaluation and management

of patients with Rheumatic Heart Disease

(DURHAM, NC, Jan. 4, 2023)—Acute rheumatic fever and rheumatic heart disease (RHD) pose major health problems globally and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease. It plays an invaluable role in detecting the presence of subclinical disease and assessing the need for prompt therapy or follow-up evaluation.

The American Society of Echocardiography (ASE) released a new guideline document, Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography, which provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. This document was endorsed by 25 ASE International Alliance Partners and is published in the January 2023 issue of the Journal of the American Society of Echocardiography.

The document is an update to previous guideline documents originally published in 2007 and 2009 that focused on valvular stenosis or valvular regurgitation etiology. This new guideline is the first document that addresses all cardiac abnormalities caused by RHD.

ASE’s lead author Natesa G. Pandian, MD, FACC, explained echocardiography is indispensable in managing the disease, and it is important for physicians to learn and teach how to apply echocardiography in the evaluation of RHD to treat patients.

“RHD is a global and regional burden in both economically constrained and advanced countries. The disease can evolve anywhere where there is a lack of sanitary conditions, access to primary care and health education,” he said. “It starts with a sore throat and fever, and if it is not recognized as a Streptococcal infection and treated, it can go on to cause rheumatic fever, cardiac inflammation, and chronic heart disease with a spectrum of debilitating lesions. Often, chronic lesions are recognized late because of slowly evolving symptoms. Echocardiography, with its multifaceted imaging approach, plays a critical role in the diagnosis, assessment of severity, detection of complications and in guiding therapy.”

This document and all guidelines published by ASE are available at ASEcho.org/Guidelines.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, Twitter, LinkedIn, or Instagram.


PDF of news release

November JASE-Enhancing Stress Echo

The November JASE includes, “Passive Leg Raise Stress Echocardiography in Severe Paradoxical Low-Flow, Low Gradient Aortic Stenosis,” from Drs. Buffle, Papadis, Boscolo Berto, Grani, Seiler, and de Marchi. Dr. de Marchi noted, “Stress echocardiography has been relying on dobutamine, also for patients with aortic stenosis. This study evaluates an increase in LV filling using passive leg raise in both, classical and paradoxical low-flow low-gradient aortic stenosis. It shows that adding leg raise to dobutamine increases the parameters we wish to stimulate in stress echocardiography.”

Two other clinical investigations also look at novel applications of stress echo. Additional clinical investigations explore optimum indexing of cardiac measurements, fetal echo prediction of postnatal obstruction in total anomalous pulmonary venous connection, cardiac function and pulmonary hemodynamics in infants with Down Syndrome, and echocardiographic imaging of myocardial scar, with an accompanying editorial, “Detecting Scar in Echocardiography: Has the Power Shifted?” from Drs. Appadurai and Thomas. A review article, which offers CME, explores tricuspid regurgitation related to cardiac implantable electronic devices. A group of robust brief research communication on validation of alternative left atrial indexation methods in obesity, development of a new technique for ultrasound imaging of the innominate vein and the venous angle, local arterial stiffness assessment, and assessment of diastolic energy loss in hypertensives versus controls and thought-provoking correspondence round out the issue.

The President’s Message from Stephen H. Little, MD, FASE, illustrates how ASE is making sure that it is preparing, planning, and prioritizing to be a leader in how Societies grapple with all of the digital data that is part of general society and of course, echocardiography. The continuing education and meeting calendar outlines a multitude of learning options near and far.

ASE Releases New EchoGuide App


Contact: Angie Porter

American Society of Echocardiography Releases New EchoGuide™ App
The mobile and web app provides quick access to common and challenging echocardiography measurements and values

(DURHAM, NC, Nov. 9, 2022)—The American Society of Echocardiography (ASE) announced today that it is launching a new interactive mobile and web application for healthcare professionals providing cardiac care. EchoGuide™ is a calculator and algorithm app based on key guidelines published by ASE.

The free app offers physicians and sonographers quick access to common and challenging echocardiography measurements and values. Tools and functionalities are organized by cardiac structure and include over 50 complex calculators, charts and algorithms that provide quantitative assessment.

“The ASE EchoGuide app is a fantastic tool for echocardiographers, sonographers, and fellows in training that brings the comprehensive ASE guidelines to their fingertips. This practical app includes key reference tables, calculators, and easy-to-use multi-parametric integrative algorithms to increase your confidence level when interpreting or performing echocardiographic studies,” says Enrique Garcia-Sayan, MD, FASE, University of Texas Health Center in Houston.

One unique feature available to users is the ability to select their favorite and most-used interactive tools for easy access. Popular topics include the left and right ventricle, left and right atrium, valves including aortic, mitral, tricuspid, pulmonic and prosthetic, and z-scores for aortic root, among many others.

EchoGuide™, sponsored by Abbott, was developed by technology consultancy and custom software development firm Digital Mettle Custom Software based in Raleigh, N.C. The app is intended for educational/informational use only, and is not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease by aiding clinical decision-making. Learn more at ASEcho.org/EchoGuide.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, Twitter, LinkedIn, or Instagram.


CMS PFS and HOPPS Final Rules



On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1770] Final Rule, which includes final policies related to Medicare physician payment and the Quality Payment Program (QPP).  In addition, CMS released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule [CMS-1772-FC], finalizing payment rates and policy changes affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings for CY 2023.

PFS Overview

Conversion Factor

The final 2023 Medicare conversion factor (CF) is $33.06, reduced from the 2022 final conversion factor of $34.61. The final rule establishes a 4.47% cut to physician payments under the 2023 fee schedule unless Congress can pass legislation that would offset or mitigate this reduction in payment.

Stakeholders, including ASE, have advocated for an improvement over the proposed rule’s 4.47% reduction to the CF, but the final rule’s methodology resulted in a slight decrease. The update is based on several factors: a statutory 0% update scheduled for the PFS in CY 20231 and a funding patch passed by Congress at the end of CY 2021 through the Protecting Medicare and American Farmers from Sequester Cuts Act. This bipartisan legislation partially mitigated a 3.75% cut to the CY 2022 CF and staved off other Medicare cuts, including a phased-in delay of the Medicare sequestration and pay-as-you-go cuts. The 3% payment patch was only in effect for 2023 and the Medicare sequestration relief was phased out starting April 1, 2022. The overall negative adjustment to the CF for 2023 is driven by the expiration of the 3% payment patch and a statutorily required budget neutrality adjustment due to other spending increases. Additionally, unless Congress acts to further delay additional anticipated cuts arising from pay-as-you-go federal budget requirements, Medicare payments could be cut by an additional 4%.

Physicians are concerned that full relief may not be possible given the significant cost of trying to offset an almost 4.5% cut and numerous competing interests facing Congress in an end-of-year legislative package. ASE will continue to work with a coalition of national and state medical societies in urging Congress to prevent these cuts before January 1, 2023. 

Practice Expense

Last year, CMS finalized a proposal to update prices for clinical labor through a four-year transition period that will be completed in 2025. Physician specialties with substantially higher average shares of direct costs attributable to clinical labor are anticipated to see increases in payment from the clinical labor pricing update, while those with lower average shares of direct costs attributable to labor are anticipated to see decreases in payment. During the four-year transition period, clinical labor rates will remain open for public comment.  Unfortunately, echocardiography related services did see an increase in the clinical labor RVUs based on the revised calculations.

Although CMS did not propose a methodology for updating future PEs, CMS believes “it is necessary to establish a roadmap toward more routine PE updates.” CMS also opined that indirect PEs would benefit from a data refresh, and signals “[its] intent to move to a standardized and routine approach” to valuing indirect PEs. Unfortunately, CMS notes that it received few direct responses to many of the specific prompts included in its recent request for information and feedback. Most commenters, including ASE, recommended CMS delay any changes to update the indirect PE survey inputs and urged CMS to wait for the American Medical Association (AMA) data collection effort prior to implementing any changes. The AMA indicated it has continued to work on updates and would likely be ready by early CY 2024 with refreshed data. CMS, however, acknowledges comments that refreshed survey data alone would not address all the competing concerns that CMS must account for when allocating indirect expenses, and that the agency may look to supplement or augment survey data with other verifiable, objective data sets in the future, including data sets that are already in the public domain.

Split / Shared Visits

CMS will delay until CY 2024 the split (or shared) E/M visits policy originally scheduled for implementation in CY 2023. For CY 2023 (as in CY 2022) the substantive portion of a visit may be met by any of the following elements:

  • history
  • performing a physical exam
  • making a medical decision
  • spending time (more than half of the total time spent by the practitioner who bills the visit).

Under this change, echocardiographers furnishing split/shared E/M visits will continue to have a choice of history, physical exam, medical decision making, or more than half of the total practitioner time spent to define the substantive portion, instead of using total time to determine the substantive portion, until CY 2024. The ASE and many other specialties pushed CMS not to implement its new definition of “substantive portion” as more than half of the total visit time and we will continue to advocate against implementation of this policy change.

Merit-based Incentive Payment System (MIPS)

CMS will maintain the CY 2023 MIPS performance threshold at 75 points (same as CY 2022). This impacts the CY 2025 payment year. Please note, CY 2022 is the final year for the “exceptional bonus” for high MIPS scores. While most cardiologists continue to meet the minimum MIPS reporting thresholds, failing to satisfactorily participate in MIPS for the CY 2023 performance year will result in a 9% payment cut in CY 2025.

MIPS Value Pathways (MVPs) are intended to connect activities and measures from the four MIPS performance categories that are relevant to a specialty, medical condition, or a particular population. For the CY 2023 performance period, CMS will add 5 new MVPs to the previously announced 7 MVPs in the program. CMS will also add measures to the existing 7 MVPs.

HOPPS Overview

For CY 2023, CMS applied a productivity-adjusted market basket increase of 3.8% under the Hospital Outpatient Prospective Payment System (HOPPS) and the Ambulatory Surgical Centers (ASC) Payment System. However, CMS applied several budget neutrality and other adjustments, including a significant 3.09 percentage point reduction to account for changes to its 340B drug purchasing policy. After accounting for these adjustments, the CY 2023 HOPPS conversion factor increases by 1.67% over the 2022 value. The ASC conversion factor will increase by 3.88%, a different and more favorable adjustment largely because it is not directly impacted by the 340B-specific budget neutrality adjustment. In continuation of its existing policy, hospitals and ASCs that fail to meet their respective quality reporting program requirements will be subject to a 2% reduction.

Based on the finalized policies, CMS estimates that total payments to HOPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for CY 2023 will be approximately $86.5 billion and $5.3 billion, respectively, for an increase of approximately $6.5 billion and $230 million, respectively, from CY 2022 program payments.

Supervision by Non-Physician Practitioners

CMS further extends supervision authority to non-physician practitioners for select diagnostic services.  In 2020, in response to the COVID-19 pandemic, CMS liberalized its regulations to allow certain non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives) to supervise the performance of diagnostic x-ray tests, diagnostic laboratory tests and other diagnostic tests paid under the PFS for the duration of the PHE to the extent they were authorized to do so under their scope of practice and applicable state law. In the CY 2021 PFS final rule, CMS further revised its regulations to make the previous revisions permanent and to add certified registered nurse anesthetists to the list of non-physician practitioners permitted to provide supervision of diagnostic tests to the extent authorized to do so under their scope of practice and applicable state law.

CMS has finalized its policy to further revise existing supervision requirements to make clear that nurse practitioners, clinical nurse specialists, physician assistants, certified registered nurse anesthetists and certified nurse midwives may provide general, direct, and personal supervision of outpatient diagnostic services to the extent that they are authorized to do so under their scope of practice and applicable state law.

To view the Final CY 2022 Payment Rates – MPFS and HOPD, please log in to the ASE Member Portal and visit the Advocacy Portal page.

For further information please see:

CMS Final Rules and Fact Sheets  

CY 2023 Physician Fee Schedule Final Rule
CY 2023 Physician Fee Schedule Final Rule Fact Sheet

CMS HOPPS/ASC Final Rules and Fact Sheets    

CY 2023 HOPPS/ASC Payment System Final Rule
CY 2023 HOPPS/ASC Payment System Final Rule Fact Sheet