As cardiology accelerates its shift into the outpatient setting, ASCs are confronting new opportunities alongside mounting business, reimbursement and operational pressures.
Here are five advances reshaping the specialty, and what they mean for the ASC landscape:
1. CMS continues expanding ASC-eligible cardiology procedures: CMS’ 2026 proposed payment rule would add 276 procedures to the ASC covered procedures list, including cardiac catheter ablation, a priority for the American College of Cardiology and the Heart Rhythm Society.
The proposal marks one of the largest single-year expansions for any specialty and strengthens momentum behind outpatient cardiovascular care, particularly the growth of outpatient cardiac catheterization labs. As CMS continues broadening ASC-eligible diagnostic cath, electrophysiology and device procedures, cardiology groups are preparing to shift more low- to mid-acuity cases into ASCs, though concerns remain about reimbursement and payer alignment keeping pace with clinical expansion.
2. Outpatient cath and EP labs are proliferating: Cardiology is rapidly expanding in the ASC space. In 2024 alone, 26 cardiology-focused ASCs were opened or announced, underscoring the accelerating shift of cardiovascular care to outpatient settings.
“Cardiology is now the big hot ticket for ASCs,” Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s, noting that more centers are adding cardiac procedures, vascular stenting and device implants.
As more operators develop outpatient cath and EP labs, competition for cardiologist partnerships and program-development expertise is intensifying. Despite improved efficiency metrics reported across the specialty, including shorter OR times and faster billing cycles, operators still face major hurdles, including capital investment, equipment acquisition and building safe, scalable pathways for higher-acuity cardiovascular cases.
3. Outcomes and efficiency data are strengthening the case for outpatient cardiology: Safety and efficiency data continue to validate cardiology’s shift into ASCs. Randomized trials show many percutaneous coronary intervention, EP and atrial fibrillation ablation cases can be safely done with conscious sedation and same-day discharge. Technology improvements, including advanced ablation tools, vascular closure devices and smaller intracardiac echocardiography catheters, have accelerated this migration.
There are also faster turnovers and more predictable scheduling in ASCs compared to hospitals. Still, careful patient selection remains essential, and not all AFib ablations or PCIs are appropriate for outpatient settings. As centers demonstrate strong outcomes and transparent data, clinician hesitancy is decreasing and support for ASC migration is growing.
4. Reimbursement erosion and payer scrutiny persist: Even as outpatient cardiology accelerates, reimbursement remains a major friction point. Payers are tightening policies around site-of-service, implant costs and case complexity and hospitals are increasingly concerned about losing high-revenue cardiovascular volume as more lower-acuity cases shift to ASCs.
Despite broader procedural approval, ASC margins may narrow as operators confront rising supply costs, staffing constraints and more frequent denials. Leaders say sustainability will depend on strong payer contracting, tight device-cost management and continued operational efficiency.
5. Consolidation and platform expansion are reshaping cardiology ASC growth: Cardiology is consolidating rapidly as reimbursement tightens and operational costs rise. Private equity-backed groups, health systems and large physician platforms are absorbing smaller practices, offering capital and contracting leverage that independents increasingly need. PE activity now spans more than 20 states and is especially dense in markets like Florida, Texas and Arizona.
The outpatient shift is accelerating this trend, as practices require scale and infrastructure to support ASC growth. Deal activity remains strong, and leaders expect consolidation to intensify as site-of-service differentials narrow. While larger platforms help capture migrating cardiovascular volume, they also introduce challenges around governance, compensation and maintaining physician autonomy.
