Are ASCs ready for cardiovascular procedures in 2020? 6 insights from 2 executives

CMS will pay for certain angioplasty and stenting procedures in ASCs beginning Jan. 1, under its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule.

Becker's ASC Review spoke about the change with National Cardiovascular Partners' Tony Lafata, chief development officer, and Kelly Bemis, RN, chief clinical officer. 

Note: Responses were lightly edited for style and length.

Q: How does CMS' decision to add percutaneous coronary interventions to the ASC-payable list affect National Cardiovascular Partners' strategy for 2020 and beyond?

Tony Lafata and Kelly Bemis: For several years now, our physician partners have been performing outpatient PCI procedures in our centers on patients with private insurance. We have also been advocating and preparing for CMS to update its regulations. Back in 2014, we began the somewhat painful process of converting our facilities to hybrid centers (ASCs and office-based labs). Today, unlike our competitors, we are uniquely positioned to meet the current and future demands created by the sure and steady migration to comprehensive outpatient cardiovascular care. We have received heightened interest from interventional cardiologists, cardiovascular practices and hospital systems regarding expanding their site of service for these types of procedures. Moving forward, our strategy will bring more awareness to NCP and increase our national footprint.

Q: Are ASCs across the country prepared for this change? Why or why not? 

TL & KB: Some ASCs are prepared, but most are not. Part of the problem is that while CMS has now approved these procedures, more than half of state legislatures do not allow these procedures to be performed in the outpatient setting. For the states that do, it could be a very positive experience but does require items that are not normally found in a traditional multispecialty ASC:

  • A high-resolution fixed angio-suite
  • Specialized emergency equipment specific to cardiology
  • Well-trained and highly experienced cardiovascular staff and physicians

Q: Based on current payment rates, is it economically feasible to perform PCI in ASCs?

TL & KB: The contribution margins of these procedures are significant in the ASC setting. NCP already performs these procedures for some commercial payers, but we expect that the incremental volume from this change in reimbursement will strengthen the financial results of our centers and NCP.

Q:  How can ASCs ensure that patients undergoing PCI receive the same quality of care as patients receiving PCI in the hospital outpatient setting?

TL & KB: You must employ a highly trained and experienced team and ensure proper patient selection. Clearly, not every patient is an outpatient candidate. Having the proper screenings and protocols in place to address items such as the patient's current physical status, their comorbidities and their ability to follow discharge instructions is essential. Secondly, cardiology is a highly specialized service line, and as such requires only the most experienced staff in order to care for these patients.

Q: What's the overarching message CMS is sending with its decision to add PCI to the ASC-payable list, and what does it indicate for the future of the industry?  

TL & KB: The addition of these codes to the covered procedures list seems to be part of a larger goal aimed at empowering patients through greater choice and protecting them, when possible, from unnecessary costs by providing more options for site of service. In addition to the PCI codes, CMS added total knee arthroplasty, knee mosaicplasty, which also signals that CMS considers ASCs an important tool in helping to reduce costs to beneficiaries.

Given that these procedures are already being performed in ASCs for commercially covered patients, the rule suggests that CMS wants to empower physicians to perform these procedures for Medicare beneficiaries in the most efficient and appropriate site of service based on the patient's needs. I think CMS recognized that, for some beneficiaries, the decision to perform the intervention in the hospital outpatient department as opposed to an ASC was being made entirely based on the payer and not on a clinical decision that reflects the patient's needs.

Q: What other types of coronary procedures do you think CMS might add to the ASC-payable list in the next five years?

TL & KB: CMS requested feedback on a number of other procedures, including atherectomy and thrombectomy. It's a clear signal that those are among the procedures they will consider in the future. While we expect CMS to move forward cautiously, there is growing evidence that more cardiac endovascular procedures are appropriate for the ASC. Given CMS' goals to empower patients and physicians to make more efficient choices when possible, it is highly likely we will see additional cardiac procedures added to the covered procedures list over the next several years.

Want to participate in future Becker's Q&As? Email Angie Stewart: astewart@beckershealthcare.com.

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