Cardiology is becoming one of the fastest-growing specialties in the ASC space. While procedure migration and new CMS approvals create major growth opportunities, cardiology also brings hidden costs and regulatory hurdles that can drain profitability if left unaddressed.
Here are five things to know about cardiology vis-a-vie ASCs:
1. High upfront costs meet narrow margins
Launching cardiology as a practice and specialty in an ASC requires major investment in catheterization labs, imaging systems and implants. But reimbursement for ASC-based cardiac procedures often trails hospital outpatient rates by thousands of dollars per case, creating a tight margin environment.
“Cardiology requires a lot of different equipment,” Prashanth Bala, chief of ambulatory surgical services at Shields Health in Quincy, Mass., told Becker’s. “It requires costly implants. Especially if those implants aren’t reimbursed or if the capitated rate for that procedure isn’t reimbursing the implant, you may not be able to do those procedures in the outpatient setting.”
2. Reimbursement lags despite efficiency gains
ASCs have improved efficiency in cardiology — average OR times for cardiology cases fell nearly 28% year over year, from 48 to 34.7 minutes. But net revenue per case also declined about 8%, from roughly $5,014 to $4,611.
3. Regulatory barriers slow growth
State certificate-of-need laws and outdated licensing standards continue to stall cardiology ASC development in many markets.
“One of the biggest challenges that we experienced when we were doing the CON was the fact that the state manual for the CON for a [cardiac catheterization] lab was written, in the ’80s or ’90s, many years ago, when outpatient cath labs were just not a thing,” Danielle Martin, an administrator and director of physician services at Richmond-based Virginia Cardiovascular Specialists told Becker’s.
4. Specialized staffing adds operational complexity
Unlike general surgery or orthopedics, cardiology requires highly trained cardiac nurses, radiology techs and EP staff. Recruiting and retaining these specialists can be costly, particularly as workforce shortages strain supply.
5. Hospitals and payers push back
Hospitals are reluctant to cede high-margin cardiology cases to ASCs, and payers have been slow to update coverage and reimbursement policies. “[Hospitals] don’t want to lose these cases …. They’ve spent millions building cath labs. If all that volume goes to the ASCs … how could they backfill those labs?,” Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker’s.
