Cardiology’s shift to the outpatient setting has accelerated in recent years, thanks in part to increased support from CMS and sustained advancements in surgical technology.
Between 2018 and 2023, the number of single-specialty cardiology ASCs grew from 55 to 221, accounting for about 4% of all Medicare-certified ASCs in the U.S., according to a July 7 article published in JACC. Additionally, the volume of cardiovascular services performed in ASCs is projected to grow by 15% between 2023 and 2028.
While its shift has not happened overnight, the cardiology landscape still represents a major symbol of what is possible in both inpatient and outpatient settings, Richard Chazal, MD, medical director of heart health at Fort Myers, Fla.-based Lee Heart Institute, told Becker’s.
“When I first started practicing cardiology, the standard hospitalization for a heart attack was 10 days!” he said. “And now data at our institution show that we discharge most of our heart attacks within 24 hours. So science and healthcare have migrated to the point where maybe in the future, we’ll be converting hospital beds to advanced outpatient centers.”
He noted that while cardiac catheterizations have been performed in freestanding centers for the last 20 years, it’s other procedures that are driving the recent wave of outpatient migration.
“What’s relatively new is the performance of coronary interventions in freestanding centers. Historically, we used to do those only in hospitals that had backup bypass surgery because of the risk of requiring such emergently,” Dr. Chazal said. “But in the current age, that’s really pretty rare. And so by and large, that requirement has been substantially loosened, and now we require on-site surgical backup only in the very highest-risk procedures. Generally, patients can be screened for risk with interventions done safely. Peripheral interventions have been done for many years in freestanding centers with good outcomes.”
Electrophysiology procedures, especially ablations, have also been a significant driver of outpatient cardiology’s growth, Dr. Chazal noted. CMS approved EP procedures for the ASC setting with the finalization of its 2026 rules in November, which were historically covered only in hospital outpatient departments.
Industry groups, including the American College of Cardiology and the Heart Rhythm Society, have long advocated for expanding the ASC-covered procedures list, citing advancements in technology, workflow and safety protocols.
For ASC leaders looking to expand cardiology centers or venture into the specialty for the first time, safety and quality must remain top priorities, Dr. Chazal said. He suggested looking to professional cardiovascular societies for guidance.
“The American College of Cardiology, the American Heart Association, the Society for Cardiac Angiography and Intervention, Heart Rhythm Society and others have guidelines and instructions regarding, for example, appropriate patient selection for these types of outpatient procedures,” he said. “Use such guidance rather than personal opinion. Reliance on professional standards that are backed up by data and a professional consensus is wise.”
