New electrophysiology codes have opened the door for ASCs to take on more complex cardiology cases. But one cardiac electrophysiologist warned that the specialty leaves little room for error.
“You have one outcome that’s bad and you’re done basically in this field, in this realm, reputation wise and the hospitals are ready to pounce on you,” Dale Yu, MD, a cardiac electrophysiologist in Dallas, said during a panel at Becker’s 32nd Annual The Business and Operations of ASCs event.
The panel, “How ASCs Can Prepare for the Outpatient Cardiology Wave,” was moderated by Becker’s reporter Ella Reuter. Panelists described the gaps that most often trip up centers adding cardiology, particularly multispecialty sites built around orthopedics or neurosurgery.
Cardiology is not just another service line. Dr. Yu said the first ASC he joined was a neurosurgery- and orthopedic-heavy center that treated cardiology as an add-on. He described it as learning another language, with electrophysiology an additional language on top of that. At one center, the existing X-ray equipment could not support the cardiac rhythm management cases he was doing. The center upgraded, but had no radiologic technologist to run the new machine, so a device company representative operated it for one of his cases.
He said centers also need to ask whether they can perform post-op X-rays and whether they stock equipment such as pericardiocentesis trays, which orthopedic programs rarely need.
Patients can look stable, until they aren’t. Dr. Yu said electrophysiology patients may appear well enough for outpatient care, then go into cardiac arrest on the table and require transfer to a hospital. “That’s the big shift in mindset from an orthopedic type of case,” he said.
Staffing costs more, and it should. Bruce Steck, administrator of Tri City Surgical Centers in Mesa, Ariz., said putting staff trained on orthopedic cases in front of medically complex cardiovascular patients becomes “almost a danger” to patients. He estimated centers should expect to pay 20% to 30% more for well-trained cath lab circulating nurses than for the circulators they typically hire, and 30% to 40% more for radiologic technologists. His center prefers staff with at least two years of hospital experience so they can recognize and respond to emergencies.
An electrophysiologist belongs at the table. Dr. Yu said every ASC rolling out electrophysiology cases needs an experienced electrophysiologist involved, in part because skilled EP nurses and techs are unlikely to join a center without one.
Patient selection still decides the venue. Mitesh Amin, MD, CEO of Aligned Cardiovascular Partners in Richmond, Va., said his team weighs three questions before moving a case: whether the procedure is appropriate for an ASC, whether the patient is, and whether the facility is prepared with the right staff, equipment and anesthesia coverage. Dr. Yu said complex ventricular tachycardia ablations, along with patients with significant comorbidities or an anticipated overnight stay, still belong in the hospital.
The panelists agreed the clinical skill exists to move more cardiology cases outpatient. The work for ASC leaders is building the staff, equipment and protocols to support those cases before the first one is scheduled.
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.
