As CMS expands its coverage of cardiovascular procedures performed at ASCs and new technologies redefine what is possible in the outpatient setting, ASC leaders are paying close attention to the growth and sustainability of cardiology service lines.
Three ASC leaders say that while cardiology’s outpatient expansion has significant potential impact for healthcare access and ASC growth, slim margins, safety concerns and vendor pricing pressures can put cardiology service lines in a precarious position.
Here’s what three ASC leaders have recently said about cardiology’s outpatient migration:
1. Paul Haas, MD, an electrophysiologist at Peoria, Ariz.-based Cardiac Solutions, said that while EP is the main driver of financial success at his organization, cardiology ASCs shouldn’t discount the importance of other interventional procedures.
“They may not be the higher [revenue] producing procedures, but they’re not money losing procedures. They keep the lights on in a lot of ways, and keep our staff gainfully employed. For example, if I take a week off, yes, it may not be as financially lucrative. But they fill that in with other procedures, and that’s what keeps employees happy,” he said. “I think for people who are looking at opening an ASC, yes — it’s great to just look at the EP side of things. But you do also have to include the interventional procedures as well.”
2. Amanda Ryan, MD, an interventional cardiologist and CEO of Advanced Heart and Vascular Center of New Mexico, cautioned ASCs against getting overly excited about revenue numbers for new cardiac procedures due to the high equipment costs associated with outpatient cardiology.
“You can find yourself in the negative on a case very quickly if anything goes beyond routine,” she said. “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.”
3. Bruce Feldman, former administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., said that safety should remain a central concern for ASCs taking on increasingly higher acuity patients.
“Hospitals today are pushing more and more cases that were traditionally done in a hospital setting into the ASC because they want to free up their ORs,” he told Becker’s. “But an ASC isn’t necessarily in the best interests of every patient.”
Patients with significant comorbidities, advanced age or complex procedural needs are better served in a hospital environment, Mr. Feldman said, a distinction he argues is getting lost as financial pressures drive the push toward outpatient migration.
“That envelope is being pushed right now,” he said. “We’re seeing higher-acuity cases moved into ASCs, and most ASCs are not equipped to handle that level of complexity.”
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