Dr. Ronald Hirsch: The outpatient cardiology shift is coming

It's only a matter of time before revenue-generating cardiology cases shift from hospitals to ASCs, a transition that has great implications for Medicare costs, according to Ronald Hirsch, MD, who wrote an analysis on the matter for the Healthcare Financial Management Association.

Eight takeaways from his paper:

1. CMS added 17 cardiac procedures, including left and right heart catheterization and cardiac angiography, to the list of ASC-approved procedures in 2019.

2. In 2016, outpatient hospital settings performed more than 523,000 cardiac catheterizations on Medicare beneficiaries using the CPT codes that are now approved for ASCs. This amounted to an estimated $682 million in Medicare payments.

3. Coronary angiography and interventions such as stent placements are often performed electively. Previously, Medicare required those types of testing to be performed in a hospital.

4. Peripheral vascular interventions were the only cardiovascular procedures permitted in ASCs last year, and Medicare billed just 31 surgery centers for the procedures.

5. The freedom to perform cardiac catheterization and angiography in ASCs may lead more centers to add those offerings to their services. Additionally, Dr. Hirsch said, it creates reason for cardiologists to consider investing in ASCs.

6. Large cardiology groups could stand to gain from having at least one physician performing elective procedures at ASCs, according to Dr. Hirsch.

7. Dr. Hirsch cautioned that CMS' additions could incentivize a physician to perform elective coronary angiography at an ASC and then schedule a stent at the hospital. By doing so, physicians could capture a second professional fee.

8. CMS' approvals could decrease or increase Medicare costs, depending on a case's circumstances, according to Dr. Hirsch. The decision also has serious implications for hospital finances.

"The financial implication [of] CMS's new ruling for both hospitals and the Medicare program bear close consideration," Dr. Hirsch said. "Clearly, hospitals would take a major financial hit if such testing were to shift from hospitals to predominantly ASCs."

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