As ambulatory surgery centers (ASCs) become increasingly attractive as a high quality, lower cost site of care for appropriate patients, cardiovascular procedures may be the next wave of higher acuity cases moving from hospital operating rooms to free-standing centers.
“Cardiovascular surgery is something we have traditionally thought we could only do in a hospital setting because it’s so delicate and, at the end of the day, we’re talking about issues of the heart,” says Temitope Oluwayomi, supply chain manager at Regent Surgical Health. But today, a growing number of surgery centers are successfully performing cardiovascular procedures including angiograms, angioplasties, atherectomies, and placement and removal of loop recorders, pacemakers, and defibrillators.
“We are bringing in cases that are higher acuity, and I think that’s really amazing,” Oluwayomi says. “Many of these procedures are possible in ASCs now because they use catheter-based treatments that don’t require large incisions.”
Moving such cases away from the hospital setting offers advantages across the board, Oluwayomi says. Procedures can be done at lower cost, with quicker turnaround times, and the move helps alleviate scheduling delays for hospital ORs, freeing them to expedite higher acuity cases while still producing quality medical outcomes, and often, a more positive patient experience.
“We find that patients generally prefer to have their cases done in the surgery center where they don’t have to navigate that huge (hospital) building,” Oluwayomi says. “They can be attended to in a quicker way, they don’t have to navigate so many hallways and elevators to get where they’re going, or deal with so many different personnel. I think sometimes even the mere thought of going to a hospital may give people anxiety. Going to a smaller setting where you have more focused attention helps alleviate some of those fears.”
And for physicians, quicker turnaround time in an ASC means they get more cases done in less time. “Better turnaround time in an ASC ultimately leads to improvement in their lifestyle,” says Oluwayomi.
The team at Regent Surgical Health is experienced in facilitating the move of cardiovascular procedures to the ASC setting. Oluwayomi outlines three considerations for ASCs interested in hosting these procedures:
• Feasibility: Viability varies by market. For example, a first mover advantage may be possible in markets where ASCs are not yet doing cardiovascular cases. Regulations in different states will also dictate the specific types of cases that can be completed in an ASC. Oluwayomi suggests doing thorough homework on potential case volume, distribution of physicians employed by hospitals versus those who are independent, expansion costs, etc. to determine if the returns will justify the investment.
• Facilities: a slightly larger operating room and specialized equipment for conducting the procedures as well as monitoring and measuring patient response are needed to support cardiovascular cases. Oluwayomi estimates that the cost to expand an existing ASC for cardiovascular procedures can range from under $1 million - $2 million, depending on equipment already on hand and needed modifications.
• Reimbursement: The way cardiovascular cases are reimbursed is one unique aspect of these procedures for ASCs to consider. Because some cardiovascular cases have higher reimbursement in the Office-Based Lab (OBL) setting, with others higher in an ASC setting, Oluwayomi says many opt to register as both. “Sometimes what you see is a situation where maybe twice a week that same facility would operate as an OBL and the remaining three days it would operate as an ASC depending on what’s going to pay better in what setting. It’s about maximizing your revenue,” she says.
To learn more about adding cardiovascular procedures to your ASC, contact Regent Surgical Health to request an ambulatory strategy assessment.