Cardiology’s shift to the outpatient setting is accelerating, but leaders say anesthesia capacity could become a limiting factor as more complex procedures move beyond the hospital.
In its 2026 final rule published Nov. 21, CMS approved four cardiovascular codes for electrophysiology studies and ablations and three codes for percutaneous coronary intervention. The move builds on a broader trend toward site-of-care migration. A scientific statement published in November by the Journal of the American College of Cardiology described electrophysiology as the next specialty poised for outpatient growth, following interventional cardiology’s trajectory before CMS expanded ASC coverage for cardiac catheterization and PCI in 2020.
The pipeline is already visible in the numbers. The volume of cardiovascular services performed in ASCs is projected to grow 15% between 2023 and 2028, according to a July 7 article in JACC. And from 2018 to 2023, the number of single-specialty cardiology ASCs grew from 55 to 221, about 4% of all Medicare-certified ASCs in the U.S.
But as more ablations and PCI cases head outpatient, operators and anesthesia groups are warning that staffing shortages may slow the pace of expansion.
Kristen Richards, vice president of ambulatory care at Lafayette, La.-based Cardiovascular Logistics, told Becker’s that anesthesia coverage is quickly becoming one of the key operational hurdles, particularly for EP procedures.
“We are currently seeing a national shortage of anesthesiologists and CRNAs,” she said. “Cardiovascular ASCs should already be pursuing anesthesia coverage for their facility in preparation for cardiac ablations, along with acquiring the appropriate anesthesia equipment, EP mapping equipment, developing anesthesia protocols and revising their patient selection criteria to ensure the right patient, for the right procedure at the right facility.”
Workforce projections suggest those constraints may intensify. A 2025 Medicus Healthcare Solutions white paper projected a shortage of 6,300 anesthesiologists by 2036, driven by rising procedural demand and a training bottleneck as residency growth lags workforce needs.
At the same time, retention is under pressure. According to the same report, 40.6% of anesthesiologists said they plan to leave their current roles within two years, citing burnout, staffing strain and reimbursement pressures.
Megan Friedman, DO, chair and medical director at Pacific Coast Anesthesia, told Becker’s the specialty is increasingly central to outpatient cardiology, even in settings that have historically relied on moderate sedation.
“Catheterization labs and outpatient cardiology centers are very good at moderate sedation, but we’re actually seeing a trend where cardiologists want anesthesiologists involved because things go better and they feel safer,” she said. “Some outpatient cases actually require general anesthesia. So we’re becoming more involved in these cases.”
