Cardiovascular ASCs, Medicare's next move & more — 4 Qs with CEO Tim Price

Cardiovascular Centers of America was founded earlier this year to fill a long-overlooked need in healthcare: helping cardiologists create and run outpatient centers.

Tim Price, the management company's CEO, spoke to Becker's ASC Review about major opportunities in the cardiovascular space and what to expect in the future.

Note: Responses have been edited for style and clarity.

Question: Why does Cardiovascular Centers of America see a big opportunity in the cardiovascular space?

Tim Price: We work with interventional cardiologists, interventional radiologists [and] vascular surgeons, and they've all been frustrated with what it takes to run outpatient centers. Cardiology is this unique beast where things that [could] happen in [an] ASC, they do in the office setting. If you're not in cardiology, you often don't realize that people are installing heart stents [and] doing heart diagnostics in an office and not an ASC. Medicare, we believe, is starting to catch on to this and say, "We don't want to pay for this in an office space." So, they approved heart diagnostics to be done in the ASC this year, and they actually reimburse more if it's done in an ASC than if it's in an office-based setting.

So, these individual practices that have office-based settings where they may be doing some of these procedures, if they create an ASC, they can get reimbursed more and expand their services. You can't do a pacemaker implementation in an office-based setting — but you can do it in an ASC. Same thing with a defibrillator. Once an interventional cardiologist who has an office-based lab [opens an ASC] — and that's something we can help them with — they can do most routine cardiovascular procedures. We don't do high-risk surgeries in the outpatient setting; those get referred back to the hospital. But 90 percent of what happens in a cardiovascular office setting can be done in these outpatient settings owned by a physician.

Q: You said Medicare is seeing that procedures done in office-based labs can be done at a lower cost in ASCs. Do you think commercial insurers will follow Medicare's lead?

TP: Usually, when you think about other specialties, Medicare has been the leader. But [with cardiovascular procedures], commercial payers have been leading the way and Medicare's just now playing catch up. We actually can get reimbursed for things from commercial payers in the office-based setting that Medicare doesn't even cover. Our existing facilities in Missouri — St. Louis Cardiovascular Specialty Surgery Center and St. Louis Cardiovascular Institute — already have contracts with United, Blue Cross Blue Shield, Anthem. Every [commercial insurer] we've wanted to, we've been able to get contracts with.

Medicare is also looking at how much they save, and this is a win-win-win — for, really, everyone but a hospital. The physicians enjoy better quality of life working [in] an outpatient setting that they have ownership in. Patients love it, just as in any other space. And the cost to the payers — commercial insurance, Medicare, and now [more] than ever, the actual patient — can be [halved] in an outpatient facility. Medicare sees that, and they're going to have to get on the bandwagon.

Q: What are some other hurdles you're facing?

TP: There are a large number of states that do have restrictions on whether or not you can do what's called a cardiac catheterization in a setting that [doesn't have] open-heart surgery. For instance, Pennsylvania has laws on the books that say cardiac catheterization must be done with open-heart surgery backup, i.e., if something goes wrong, you can roll them right into open-heart surgery. About half the states or less have something like that. It's a very antiquated point of view. This is an area where we might have to be politically active … because we can provide that care for so much less than the hospital.

And technology has progressed to such an extent that [with] these procedures, the chances of someone being transferred from a heart diagnostic catheterization to open-heart surgery is extraordinarily small. Hospitals were on the creation end of some of those laws, and we believe those won't be sustainable in the long run — especially given the increasing cost of healthcare and the trend toward outpatient care.

Q: Why do you think it's important to bring together ASCs and office-based labs?

TP: We are leading-edge in creating what I'll call facility-based office-based labs. There's certain procedures [that] have to be done in an ASC to get reimbursed. Those are some major ones for us — such as pacemakers, defibrillators — that we think are very important to our service line.

You can't perform everything in an office-based lab as a cardiologist. They need ASCs plus an office-based lab. In the last 15 years, they went hospital-employed because payers weren't on board [and] Medicare wasn't on board. We believe the trend will be away from hospital employment, as Medicare has signaled this year. And they're [asking], "Why are we spending billions more than we need to by having these procedures done in a hospital, when, really, they should be done in an outpatient setting?" We believe they're signaling [a change] by allowing heart diagnostics to be done in the ASC and reimbursing [ASCs] more [than office-based labs for] heart diagnostics. The intervention's not approved yet, but we believe that's next.

If you'd like to participate in future Becker's Q&As, contact Angie Stewart at astewart@beckershealthcare.com.

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