As cardiovascular procedures continue to shift to outpatient settings, ASCs are navigating unprecedented demand, evolving technology and new operational challenges.
During Becker’s 31st Annual Meeting: The Business and Operations of ASCs in Chicago, two physicians working at the forefront of this transformation shared what it really takes to build and sustain a successful single-specialty cardiology ASC.
The panel featured Jon George, MD, an interventional cardiologist at Philadelphia-based ReVamp Heart & Vascular Institute and Andre Gauri, MD, chief quality officer of the Heart and Vascular Institute at Grand Rapids and Southfield, Mich.-based Corewell Health.
Why cardiologists are moving to outpatient
For Dr. George, the shift to the ASC setting was motivated by both clinical progress and structural frustration.
With more than a decade in academic, hospital-based cardiology, he said he was drawn to private practice by the ability to innovate more freely. “What excited me about going into cardiology was really being at the forefront of clinical care,” he said. As hospitals became more cumbersome environments for introducing new procedures, research and training programs, he began planning an outpatient surgical center.
“It took five years to get it off the ground,” he said. “It takes time, and it takes a lot of planning.”
Clinical advancements have also opened the door for more procedures to move safely outside the hospital. Angioplasty once required a cardiac surgeon standing by overlooking the procedure; today, complication rates are far lower. “It’s evolving,” he said. “I don’t think anything’s evolving faster than cardiology in the last several decades.”
Dr. Gauri agreed, noting the pace of innovation in electrophysiology.
“As an electrophysiologist, [atrial fibrillation] ablations … how I did it 25 years ago compared to how I do it now is literally night and day,” he said.
Both physicians pointed to CMS’ expanding ASC covered procedures list as an accelerator for outpatient cardiology volume.
Managing growth without compromising safety
As more cardiac procedures move outpatient, centers must keep up without sacrificing outcomes.
At Corewell Health, Dr. Gauri oversees clinical and operational cardiovascular programs. He said the biggest challenge is matching capacity to need. High volumes of atrial fibrillation cases are placing pressure on scheduling.
He noted that wait times have grown so long that a patient seen today wouldn’t get an ablation until many months later, a delay, he said, “just isn’t right.”
Efficiency, both clinical and operational, is key. He said the system needs stronger, more efficient processes to deliver safe, high-quality care.
Dr. George said ASCs offer a level of flexibility hospitals often struggle to match.
In many hospital catheterization labs, he noted, the number of “turnovers in a room … [they’re] so variable.” In contrast, ASC design supports nimble, physician-driven workflows.
“If you lose that, then you lose the advantage of doing it in that surgery center,” he said.
Staff engagement also plays a role. Dr. Gauri noted that in hospitals, “the staff aren’t incentivized to move fast … they’re incentivized to do a safe job,” but not necessarily an efficient one.
In ASCs, he said, staff can be part of an incentive model where “the more efficient they are, the better it is for them, as well.”
What makes an ASC sustainable?
The panelists agreed that long-term sustainability for cardiology ASCs hinges on efficiency, adequate volume and disciplined financial planning. Dr. George said his model centers on three pillars: cost, quality and outcomes.
“If you don’t maintain that rhythm, then that sustainability goes down,” he said.
Procedural volume, especially ablations and other higher-acuity cardiovascular cases, will ultimately determine whether a single-specialty center can stand on its own.
As Dr. George noted, “If you are just doing diagnostic cath procedures, that’s probably not sustainable.”
He added that thoughtful space planning is also critical. His center is starting with one lab, but intentionally designed the facility to allow for future expansion. Depending on case mix and volume shifts, bringing in additional cardiovascular or related specialties may be necessary to support long-term stability.
One of the biggest variables, he said, is reimbursement.
“What happens with reimbursement?” he asked. “You just have to be open to thinking about all of those things,” including potential changes to site-of-service payments and long-term financial alignment.
The hidden work behind opening an ASC
When asked which parts of the ASC development process required more oversight than he expected, Dr. George didn’t hesitate. “All of it,” he said.
Navigating city and state regulations, union labor requirements, repeated inspections, real estate decisions and evolving Department of Health rules turned his project into a multi-year undertaking. He initially managed the process himself before bringing in a management partner to handle the operational lift. “You can’t do it all,” he said.
Dr. Gauri noted that even large health systems face the same challenges. At Corewell, leadership ultimately chose to partner with an ASC management company rather than build and operate a center independently.
“They didn’t feel that they had the skill to run an ASC on their own,” he said. Joint ventures can ease administrative burdens, he added, but typically come with a shared financial return.
Recruiting and retaining ASC staff
Because both centers are early in their launches, recruitment strategies are still evolving. Surprisingly, both physicians said staff compensation in ASCs can exceed hospital pay despite more favorable hours.
Dr. George noted that outpatient positions are appealing: “There’s no call and there’s no late nights. … They do get paid higher in the outpatient setting, so it’s a win-win.”
However, Dr. Gauri raised an important concern: avoiding a drain of top hospital staff to outpatient facilities. Hospitals will continue to handle higher-acuity patients, requiring experienced personnel. Balancing staffing across both environments will be essential.
Innovation that is transforming care
When asked about the most meaningful innovations shaping their work, Dr. George pointed to the operational and educational capabilities built directly into his ASC, elements that would require months or even years of approvals in a hospital setting.
His center was designed to support training, research and live case broadcasting.
“We can do live cases from our angio suite to a national meeting,” he said, adding that the ability to move quickly on new technologies and programs was a major motivator for opening the center.
Dr. Gauri highlighted the clinical transformation underway in electrophysiology, particularly with the adoption of pulse field ablation. The technology significantly enhances safety by sparing surrounding structures such as the esophagus. “Doing an AFib ablation is much less stressful as a physician … and it’s twice as quick,” he said.
The technology is still expensive, but both physicians expect costs to come down as more procedures move outpatient.
“For the first time, doctors are going to be really, really caring about what they spend,” Dr. Gauri said, noting that the ASC environment naturally drives price sensitivity and competition.
Addressing hospital revenue-loss concerns
When asked how ASC reimbursement compares with hospital rates, Dr. Gauri said it is “about 20% less than hospital reimbursements.”
He noted that the specific codes for AFib ablation in the ASC setting “haven’t come out yet, so we don’t know exactly what it’ll be, but it’s gonna be less.”
Even so, both physicians emphasized that hospitals resisting the outpatient shift risk losing cardiovascular market share as payers and patients increasingly favor lower-cost sites of care.
“You’d rather have something than nothing,” Dr. Gauri said, explaining that forward-thinking systems are partnering with physicians early to stay aligned as more procedures move to ASCs.
Dr. George added that hospitals will still play a critical role, especially for higher-complexity patients and procedures that ASCs “do not — and cannot — take.”
