As more cardiac procedures move into the ambulatory setting, developers are taking different approaches to what that shift should look like.
AlignedCardio, a Richmond, Va.-based cardiovascular group formed through a partnership between James River Cardiology and RC Capital, a healthcare-focused private equity firm, is testing a different model: a network of smaller ASCs integrated into the neighborhoods where patients already live.
Mitesh Amin, MD, CEO of AlignedCardio and president of South Park Heart and Rhythm Center, said the approach reflects how he has seen patients actually behave.
“We’ve seen the ASC as being an extension of our clinic and kind of embedded in the community where patients need the care the most,” Dr. Amin said. He said he is aware of other developers building centralized facilities on the theory that patients will travel a distance for a “mini heart hospital.” AlignedCardio’s bet is the opposite: that a smaller ASC footprint closer to where patients live makes more sense, even if that means operating multiple centers within a single market.
“The community is usually a smaller, tight-knit community, and word was out that they had a good experience there,” Dr. Amin said. “The equipment obviously is the same as what we have in the hospital.” Patients now ask whether procedures they are referred for can be done at the center instead, he said, though AlignedCardio limits ASC cases to lower-risk patients.
“We are very particular about case selection, making sure that we are doing only low- to moderate-risk patients in the center, and moderate- to high-risk patients are still being reserved for the hospital,” Dr. Amin said.
Making that model work, in Dr. Amin’s telling, has come down to replicating hospital-level expertise rather than building a scaled-down version of it. Engaged physicians are the foundation, he said.
“Having our providers heavily engaged is critical,” he said. “If they aren’t engaged and they aren’t comfortable doing the cases in the center, the model doesn’t work for us.”
The equipment and staffing follow the same logic. AlignedCardio outfitted its ASC with largely the same equipment used in area hospital cath labs and staffed it with many of the same clinicians who work at the local hospital, Dr. Amin said.
“It wasn’t inexpensive,” he said. “But it makes sense to have that same experienced team there that’s in the hospital. I think those are the things that have made a difference.”
That same emphasis on expertise carried into how AlignedCardio built the center itself. Dr. Amin said he expected construction to be the hardest part, based on what he had heard from others in the space — but it turned out to be more manageable than anticipated, in part because AlignedCardio worked with contractors and an architect who had already built other ASCs.
Credentialing, payer contracting and licensing were a different story, he said, and took longer to work through. Getting the center certified by the Accreditation Association for Ambulatory Health Care, or AAAHC, required its own preparation.
“There are some complexities and unknowns, especially when it comes to getting the center’s AAAHC certification,” Dr. Amin said. “That piece takes some time and practice and some repetitive behavior. So we did a number of mock surveys internally to get prepared for it, and it was good not just for the survey, but also good for our team to be trained and experienced with it.”
AlignedCardio is now expanding South Park Heart and Rhythm Center from one procedure room to two by the end of the year, with a growing focus on electrophysiology. Dr. Amin said the center was the first on the East Coast to perform pulsed-field ablation in an ASC setting, and has since logged more such cases than any other center in the country, according to registry data the group is tracking. Two more centers are in development — one in Greenville, N.C., and another north of Richmond — and AlignedCardio has applications pending for a project in Northern Virginia, where it must first clear the state’s certificate-of-public-need review.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
