With CMS’ recent approval of electrophysiology ablation procedures for the ASC setting, leaders are faced with a range of new opportunities to add or expand service lines — but those opportunities come with considerable risks.
Paul Haas, MD, an electrophysiologist at Peoria, Ariz.-based Cardiac Solutions, is deeply immersed in outpatient EP work. His practice comprises 24 cardiologists, including three electrophysiologists. They opened their ASC five years ago — a joint venture with Phoenix-based Banner Health.
He recently performed his first cardiac ablation in the ASC utilizing Johnson & Johnson’s Varipulse device, a fully integrated pulsed field ablation platform designed to deliver ablations at precise locations.
Dr. Haas said that while these developments have significant potential to enhance access and efficiency in cardiac care, it’s not something to rush into.
“One of the things I’ve actually tried to do is slow the transition a little bit,” he said. “There’s still nothing wrong with doing the procedures in the hospital. And from my perspective, once people really start being able to do everything in the surgical center that’s physically possible, that’s when you’re going to get in trouble with either complications or finances.”
On the clinical end, patient selection remains integral to the success of outpatient electrophysiology.
“[According to] most studies now looking at AFib ablations, somewhere between 90% to 95% of patients that are done in the hospital go home the same day,” Dr. Haas said. “Five percent to 10% doesn’t sound like that much, but if it’s 5% to 10% that have to be transferred to a hospital to stay that night, that’s a lot. It’s way too many. You have to have patients who aren’t going to have anesthesia challenges, and they have to be healthier overall. So that’s been the real focus in terms of transitioning those patients.”
Financially, ASC leaders looking to add cardiology lines must carefully analyze their device costs due to the high utilization of expensive disposable equipment utilized for ablations.
“It doesn’t take much to take your margins to zero on these AFib ablation,” Dr. Haas said. “If you’re looking at a procedure that reimburses about $20,000 and, in general, you’re going to have about $10,000 in equipment that’s thrown away after the procedure. Anything that increases that makes it unfeasible. And even things that don’t cut into the margins as much, but make the procedure longer, that is really a similar negative.”
He added that this was a major benefit of utilizing the Varipulse platform, as it functions as a mapping tool and an ablation catheter. Typically, these would be two separate tools, increasing the cost of the procedure.
When it comes to patient safety, concerns surround individual patient risks and outcomes, but also industrywide regulations and legislative actions.
“[ASC leaders] should be really concerned about any complications,” Dr. Haas said. “There’s a lot of people looking at this very closely, especially hospital administrators and hospital lobbyists who are looking for anything that would take back the CMS approval in the surgical centers. So all of us have to be really cautious with who we do the ablations on in the surgical center.”
ASCs with strong patient selection and safety processes in place can play a key role in improving access to ablations in a time when demand for cardiovascular services among the U.S. population remains high — and so do wait and travel times for appointments.
“From a procedural time standpoint,it is just way more efficient in a surgical center,” Dr. Haas added. “[With the] turnover times in the rooms, you can fit in a lot more procedures. A lot more procedures equals more access. It’s not just ablations — but from a total cardiovascular access standpoint, you can just get more done there in one day.”
Improved access to ASCs for outpatient ablations can also free up inpatient resources for hospitals and health systems.
“There’s been so much growth in structural valve and Watchman, and that’s all still done in the hospital,” Dr. Haas said. “If you look at individual procedures, yes, there’s been a significant drop, particularly in devices, and now definitely in the AFib realm as well. But it’s just been made up in higher-acuity procedures, particularly the structural heart procedures. So, yes, it’s made a difference from that standpoint where I don’t think we would have the space and time to do all that’s done there if we didn’t transition a fair amount of that stuff to the ASC.”
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