Several leaders joined Becker’s on an Oct. 16 panel at the 31st Annual Business and Operations of ASCs Meeting in Chicago to discuss why cardiology is becoming one of the fastest-growing specialties in the outpatient surgery landscape — and what technology, regulation and care models will shape its future.
Safety data and payer pressure
Andre Gauri, MD, chief quality officer of the Heart and Vascular Institute at Grand Rapids and Southfield, Mich.-based Corewell Health, said cardiology’s momentum toward ASCs is rooted in evidence.
“In cardiology, more so than many other specialties, there’s a lot of data,” he said.
Randomized trials and published literature have shown that procedures once considered exclusive to inpatient settings can now be safely done with conscious sedation and same-day discharge.
He noted that many cardiac procedures carry high overhead in hospitals, making them attractive targets for payers looking to reduce cost.
“Insurers, I think, are really motivated to try to reduce those costs,” he said, adding that electrophysiology, interventional cardiology, vascular surgery and cardiac care broadly are “really ripe for the ASCs.”
Efficiency in the ASC environment
From an administrative perspective, efficiency is a major reason cardiology is shifting to outpatient settings, said Heather Smith, director of cardiology at Ascension in Austin, Texas.
“At a hospital, no matter how efficient you are, you can only do so many cases,” she said. “Physicians don’t like being bumped, and they don’t like having to wait for a 30-minute turnover. Where at an ambulatory surgery center, they’re highly efficient. … Their turnovers from wheels in to wheels out are a lot faster most of the time. So why not do lower-acuity cases there?”
Technology accelerating migration
Technological change has also been key to the shift, said Braden Batkoff, MD, senior vice president at Avon, Conn.-based Constitution Surgery Alliance.
“When I started my training, a standard PCI patient was in the hospital for two days,” he said. “Now we know that over a third, 40%, of our PCI patients go home the same day. Our EP patients, three-quarters of them go home the same day. Ninety-five percent of our AFib ablations go home the same day.”
Dr. Gauri added that advances in ablation technology have “skyrocketed,” making procedures safer, faster and less burdensome for patients. He also cited vascular closure tools that reduce bedrest from six hours to two.
Ms. Smith pointed to smaller ICE catheters and tools such as pulsed field ablation that reduce post-procedure discomfort and support safe same-day discharge.
The right patient in the right place
Despite momentum, Ms. Smith said cardiology cases require careful triage.
“Even if you’ve screened your patients properly, there’s always those what-if moments,” she said, adding that ASCs must quickly evaluate home support, medication access and other discharge needs.
Dr. Gauri emphasized that not every patient should move to an outpatient setting.
“Not all patients are going to be right for the ASC,” he said. “Not all AFib ablations, not all PCIs. … They’re not all created equally.”
He noted that Corewell performed about 1,200 AFib ablations in 2024 across four hospitals — volume that cannot shift overnight due to limited ASC lab capacity.
Dr. Batkoff added that cardiology ASCs will likely remain tightly integrated with health systems because “there’s still a big chunk of cardiology that’s going to be done in the hospital setting.”
Overcoming hesitation
Some clinicians remain hesitant regarding the outpatient shift. Dr. Batkoff said this often comes from unfamiliarity.
“You talk to cardiologists who were practicing in the hospital, now practice in the ASC, and they love it. And they’re not going back,” he said.
Dr. Gauri said resistance often reflects training norms.
“There are a lot of physicians and electrophysiologists I know who say, ‘I would never do an AFib ablation in an ASC.’ Even though there’s data for it, it’s just how they’ve been doing it forever, and they worry.”
Ms. Smith said transparent data from each center helps win skeptics over.
“A lot of centers have won over physicians who were on the fence because they show their own data: if something went wrong, their ambulance times, how many complications they’ve had,” she said. “That transparency of the complications, and their robust protocols and triage processes to keep patients safe, is what convinces people.”
Standards, experience and the future
Dr. Batkoff said cardiology ASCs should ultimately deliver outcomes on par with — or better than — hospitals. Dr. Gauri added that ASCs often offer a superior experience, with easier access and less complexity for patients.
Ms. Smith argued the bar should be even higher.
“Your net promoter score should be darn near perfect, and your quality should be next level, not even [a] comparison,” she said.
Looking ahead, the leaders pointed to policy and payment as major determinants of growth.
Ms. Smith said CMS’ approval of AFib ablation will accelerate outpatient migration, while Dr. Gauri noted that device reimbursement remains strong, diagnostics continue to lag and certificate-of-need laws still slow expansion in many states.
On the operational side, Dr. Batkoff urged organizations to build cardiology ASCs as integrated parts of their care systems rather than standalone facilities. Dr. Gauri pointed to Corewell Health’s joint-venture model with physicians and a management company, saying it succeeds because “everyone has strengths.”
Despite remaining challenges, all three leaders agreed the shift is gaining momentum.
“Patients love it, physicians love it,” Dr. Batkoff said. “Cardiology is just getting started.”
