The future of cardiology in ASCs: Physicians Surgery Centers' Jeff Dottl weighs in

Jeff Dottl is a principal for Physicians Surgery Centers, a professional ASC management and development company. Recently, he was asked to join an ad hoc California Ambulatory Surgery Association committee addressing cardiology procedures in ASCs. Here, he shares his thoughts on the future of cardiology in ASCs.

Note: Responses have been lightly edited for style and clarity.

Question: What are the current opportunities to add cardiology procedures to ASCs?

Jeff Dottl: There are so many opportunities. But this is undiscovered territory for most interventional cardiologists. Lewis and Clark may have already paved a route to the Pacific Ocean, but it is still going to take awhile before there is a freeway connecting the East and West coasts. In our centers, we have found that the highest level of physician comfort is with cardiac rhythm management devices. Generator changes can be done safely and without much, if any, capital expenditures since good ASCs generally already have all the equipment needed for these procedures. Primary placement of these devices is also a big opportunity for ASCs and adds greatly to the universe of potential ASC patients. Other opportunities exist for vascular-related procedures, such as atherectomies, but physician willingness/comfort is generally the limiting factor here. If the physicians aren’t comfortable performing these procedures in an ASC setting, the capital expenditures conversation isn’t worth having.

Q: What should ASCs expect from CMS in the coming years?

JD: I think that with CMS’ demonstrated willingness to expand the library of cardiology CPT codes available to ASCs, we will see more codes and procedures to follow. However, it is tough to say when. Governmental agencies aren’t known for taking quick action, which is sometimes a good thing. It is no secret, at least to those that read trade publications like Becker’s ASC, that ASCs are a very safe place for patients to have important and increasingly higher acuity surgical procedures. I doubt that we will see CMS open up a fire hydrant of CPT codes in the next year or two, but it is probably safe to assume that if we continue to safely perform these procedures, the data will eventually speak for itself and drive future expansion of the specialty.

Q: Do you see cardiology as a growing specialty for ASCs?

JD: Absolutely. But, same as any other disruption to an industry, it will require a change in strategy. ASC’s have been built around orthopedics, ENT, podiatry and other specialties. Cardiologists don’t generally mingle with this crowd since they are holed up in the cath lab all day. Nearly every cardiologist I have spoken with about coming to one of the ASCs we manage has said, “Hmm, I’ve never thought of that before.”

If the lab is full, then many hospitals push generator changes to the end of the day at the main OR, not exactly a preferred time for surgery. The frustrations encountered on a daily basis by interventional cardiologists and electrophysiologists over this kind of treatment is, frankly, a huge gift and a door-opener for the ASC industry. Once we have the ear of these providers, the opportunity to bring them in to the ASC industry in a big way is dependent upon us being able to provide a level of patient safety and physician comfort that they are accustomed to seeing at the "big house." This shouldn’t be out of reach, since ASCs typically offer higher nurse-to-patient ratios and lower infection rates, in addition to being more efficient with time.

It is no different than it is or was with any other specialty. You need to find a team captain that is willing and able to provide their insight and enthusiasm to build a vibrant and successful cardiology program in your ASC.

More articles on turnarounds:
Starting pay rises for most specialists, including orthopedic surgeons — 17 statistics
Highest-paying physician specialities & 4 other must-read articles for ASC leaders
Pinehurst Surgical Clinic cuts down on narcotic prescriptions — 6 lessons learned

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