ASE Responds to Congressional MACRA Modernization Proposal

On May 13, ASE submitted detailed comments to Representatives Joyce, Murphy, and Schrier on the MACRA discussion draft. ASE expressed strong support for the budget neutrality reforms in Title IV and the Quality Reform Task Force, while urging several amendments. On the conversion factor update in Section 101, ASE called for tying the update to the full MEI rather than MEI minus one percentage point, arguing that a structurally sub-inflationary formula will recreate the same payment decline over time. On quality payment reform, ASE raised concerns about the lack of viable MIPS and APM pathways for imaging-focused specialists and warned that the forthcoming mandatory Ambulatory Specialty Model for heart failure was developed with minimal specialty input and leaves key questions about echo attribution unanswered. ASE also joined the broader cardiovascular community in asking that Section 205 on Appropriate Use Criteria be removed from the draft and addressed instead through the Quality Reform Task Force, and expressed support for Section 203’s expanded registry access to Medicare claims data.

ASE’s comments reflect years of compounding financial pressure on echo practices, including budget neutrality adjustments, stale practice expense inputs, and efficiency reductions that produced facility-based echo cuts of up to 11% in the CY 2026 rule alone. On quality reform, ASE specifically called for imaging-focused MVPs and performance assessment tied to echo’s direct clinical contribution rather than broader episode costs. The Society continues to advocate for payment and quality policies that reflect the true cost structure and clinical role of echocardiography.