The Bipartisan Budget Act of 2015 does more than just raise the nation’s debt ceiling. It also presents significant changes in Medicare reimbursement. More specifically, new, off-campus hospital outpatient departments (HOPDs) will not receive reimbursement under Medicare’s Hospital Outpatient Prospective Payment System (OPPS). Simply put, this means these practices will not be able to take advantage of the higher reimbursement available under the OPPS. In this column we discuss the implications for cardiology practices and offer ways for cardiologists to effectively prepare for and manage the changing reimbursement environment.