As CMS expands the list of approved cardiac procedures in ASCs, independent operators are finding that reimbursement rates often fail to cover the true cost of care.
Amanda Ryan, MD, interventional cardiologist and CEO of Advanced Heart and Vascular Center of New Mexico, joined Becker’s to discuss why slim margins and vendor pricing pressures are putting cardiology ASCs in a precarious financial position.
Reimbursement for outpatient cardiology procedures has been a key issue for advocacy groups as procedures continue migrating to ASCs. When CMS finalized its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2026, it added 573 codes to the ASC Covered Procedures List, including several cardiovascular codes and electrophysiology ablation procedures. According to cardiology leaders, cuts to Medicare have resulted in a $700 million loss for cardiology services over the last five years.
Editor’s note: This interview was edited lightly for clarity and length.
Question: As CMS continues to expand the list of approved cardiac procedures, are payment rates keeping pace with the actual cost of delivering care?
Dr. Amanda Ryan: In the peripheral vascular and EP space, the revenue numbers can look high, but the costs are substantial. You can find yourself in the negative on a case very quickly if anything goes beyond routine. Even with standard equipment, you’re looking at profit margins around 15% — which is workable, but slim. And unlike a large hospital system running a billion-dollar operation at 4-5% margin, we’re working with several million in revenue at 10-15%, so there’s very little room for error.
Part of the challenge is that vendors aren’t particularly motivated to discount their devices for ASCs. There’s high demand, and there’s also fear that if they lower prices for us, they’ll be expected to match those prices for hospital systems. So we’re not getting meaningful price breaks.
CMS really needs to take a closer look at what it actually costs to deliver this care. A procedure may reimburse $20,000, but if the equipment alone costs $14,000, before you account for fixed costs like staff and facility overhead, the margin quickly goes to zero — or negative.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.