In a landscape where congenital heart disease (CHD) continues to affect a significant portion of the population, both newborns and adults alike face an array of systemic challenges that risk their access to vital interventional cardiology care. A recent landmark policy statement released by the Society for Cardiovascular Angiography & Interventions (SCAI) sheds new light on the economic barriers pervading this specialized medical field. The statement, titled “Economic Barriers to Interventional Cardiology Care for Adults and Children With Congenital Heart Disease and Potential Policy Solutions,” was published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI) and incisively diagnoses the flawed reimbursement paradigms, undervalued procedures, and sluggish innovation pathways hampering care delivery.
At its core, this position paper delivers a compelling argument that the interventional management of CHD demands expertise that transcends routine cardiologic practice. This subspecialty involves intricate, highly specialized techniques and technologies, often performed under intense time constraints and clinical complexity. Despite the sophistication required, current reimbursement protocols within Medicare and Medicaid grossly undervalue the medical labor, skill, and technological resources deployed by interventional cardiologists specializing in congenital anomalies. The economic dissonance elucidated by the authors underscores a widespread systemic failure, with cascading impacts on both clinician incentives and patient outcomes.
CHD remains a major public health concern, afflicting approximately 40,000 newborns annually in the United States alone. Alarmingly, nearly a quarter of these infants require invasive intervention within their first year of life to correct structural defects threatening survival. Beyond infancy, the unique challenges of CHD persist into adulthood, with over 2.4 million adults living with congenital heart defects nationwide. These adults rely heavily on continued access to expert interventional procedures and specialized devices tailored to their complex cardiovascular anatomies. Given the chronic and evolving nature of CHD, the necessity of a robust care infrastructure for all ages cannot be overstated.
One of the gravest inequities identified involves Medicaid payment disparities. Although Medicaid finances a substantial share—over 50% of pediatric CHD surgeries and roughly 40% of adult CHD hospital encounters—the reimbursement rates remain a fraction of Medicare benchmarks, averaging only 72%. This discrepancy not only diminishes the financial viability of congenital interventional programs serving vulnerable populations but entrenches systemic health disparities. Physicians and institutions providing care to predominantly Medicaid-insured patients operate under constrained fiscal realities, which can lead to reduced service availability and compromised quality.
Another critical factor lies in the valuation of physician work relative value units (wRVUs), which underpin fee schedules and compensation in interventional cardiology. Pediatric interventions, including life-saving catheterization techniques like balloon atrial septostomy, have long suffered from undervaluation. Despite a CPT code existing for balloon atrial septostomy for over 25 years, it remained without a wRVU assignment until very recently in 2018. Furthermore, the Centers for Medicare & Medicaid Services (CMS) have frequently rejected recommended wRVU assignments for congenital catheterization codes, with 20 of 24 codes denied proper valuation over the past three years. This persistent undervaluation signals systemic oversight of pediatric cardiac care’s complexity and importance.
Such economic disincentives translate directly into compensation disparities between pediatric and adult interventional cardiologists. The former group often earns only 50 to 65 percent of the salary packages of their adult cardiology counterparts. These gaps are starkly incongruous with the intense workload and lower procedural volume inherent to pediatric practice. On a daily basis, pediatric interventional cardiologists may conduct two to three procedures compared to eight to ten performed by adult specialists, reflecting the heightened procedural complexity and stringent safety requirements. The resultant skewed compensation undermines recruitment and retention in this critical subspecialty, threatening the sustainability of specialized care offerings.
Compounding these issues is the chronic shortage of pediatric-specific interventional devices. The pediatric device market remains markedly smaller than the adult cardiovascular device sector, leading to a reliance on off-label use of adult-designed technologies in 63% of CHD interventions. A revealing FDA survey exposed that nearly three-quarters of unmet device needs are pediatric, highlighting a glaring innovation gap. This paucity of products engineered explicitly for children hinders optimal management, forcing clinicians and patients to navigate compromised options that may not align with unique anatomic and hemodynamic considerations.
SCAI’s statement is not merely diagnostic; it serves as a call to action for comprehensive reform addressing these intertwined challenges. Central proposals include advocating for Medicaid payment parity with Medicare to redress financial imbalances and ensuring that reimbursement models truly reflect the intensive expertise and resource utilization required in congenital interventional procedures. Additionally, the statement urges reexamination and fair adjustment of wRVU assignments to properly value complex pediatric work. Alternative compensation frameworks that accommodate lower procedural volume without penalizing clinicians are also recommended to align incentives with care quality.
Moreover, accelerating regulatory pathways for pediatric device development emerges as a crucial avenue for transforming clinical practice. Streamlined FDA approval processes tailored to pediatric innovation would catalyze the availability of specialized devices, directly improving procedural safety and efficacy for this high-need population. Such regulatory reforms, coupled with coordinated industry investment, can help bridge the current gap and foster a pipeline of state-of-the-art technologies customized for congenital cardiovascular anatomies.
As underscored by Dr. Lyndon C. Box, MD, FSCAI, the lead author, the physical and intellectual demands of interventional cardiology for congenital heart disease necessitate recognition not only in policy but also in reimbursement. Enhancing support for physicians through equitable financial structures will enable them to sustain high-quality care amidst evolving clinical challenges. Fundamentally, these reforms aim to improve clinical outcomes and quality of life for patients and families often confronted with chronic, life-altering cardiac conditions from birth onwards.
Dr. Frank F. Ing, MD, MSCAI, coauthor and member of SCAI’s Congenital Heart Disease Council, emphasizes the collaborative nature of the effort needed to enact these changes. Successful reform requires multidisciplinary cooperation spanning clinical practitioners, policymakers, industry leaders, and patient advocacy groups. Only through such collective engagement can entrenched systemic barriers be dismantled, and equitable, comprehensive care infrastructure crafted for children and adults spoken for by cardiovascular interventionalists.
In sum, the SCAI’s policy statement marks a pivotal moment of reckoning for interventional cardiology in congenital heart disease. By articulating the manifold economic stressors stalling progress and detailing actionable policy solutions, it galvanizes a path forward. Achieving these reforms holds the promise to transform congenital cardiology from an undervalued niche into a thriving specialty adequately resourced, fairly compensated, and equipped to innovate continuously. This vision ultimately ensures that millions of individuals living with congenital heart disease receive the high-level care their complex conditions demand throughout their lifespan.
Subject of Research: People
Article Title: SCAI Position Statement on Economic Barriers to Interventional Cardiology Care for Adults and Children with Congenital Heart Disease and Potential Policy Solutions
News Publication Date: 30-Sep-2025
Web References: www.scai.org
Keywords: Cardiology, Medical specialties, Cardiovascular disorders, Human heart, Health care, Health disparity, Health equity
