As cardiovascular procedures, including electrophysiology, expand into the outpatient setting, ASC leaders are eyeing a new field of opportunities to close critical gaps in care while increasing patient volumes.
But cardiology comes with higher stakes than many other specialties: Wait times for appointments and procedures have reached record highs in recent years, and cardiovascular patients are at baseline more likely to be higher acuity.
Christina Hagan, director of ASC operations at Philadelphia-based Atria Health and administrator of AMS Cardiovascular, has been at the forefront of cardiology’s migration to the outpatient setting.
She told Becker’s that the work her team is doing in the ASC today is the latest iteration in nearly a decade of procedures moving to the outpatient setting.
“I was a part of the initial tracking that we did when we first started sending patients home from stents. That was a big deal, because every patient stayed over[night] after a stent. In around 2016 or 2017 we started sending people home, and we had all this strict protocol and follow-up, so they weren’t spending overnight. Now, 10 years later, nobody stays unless they have a complication,” Ms. Hagan said.
This eventually evolved into outpatient pacemaker implants and, now, electrophysiology procedures. All the while, Ms. Hagan said patient safety has remained at the center of successful procedure rollout or service-line expansion.
“If you start with patient safety, if that is your biggest priority, I personally believe that that is your key to success,” Ms. Hagan said. “It shouldn’t be about how to do this in the most inexpensive way possible so that we can get done what we want to get done, and you know, have a bigger profit margin at the end of the day. From day one, it has been about that we are going to operate a center that has all of the safety measures and protocols that we’re used to in the hospital, and then when patients come here, they not only feel safe, but we know that they’re safe.”
The process of building a strong safety culture in a cardiovascular ASC begins with establishing protocols and infrastructure that go above and beyond the basic requirements in most states.
“When I started this venture, I read from front to back Pennsylvania’s regulatory requirements for ASCs,” Ms. Hagan said. “Our policies and our procedures are all the ones that are required by the state, and then I have a whole host of ones that are directly related to cardiovascular care. I would say if you’re doing cardiology, you have to hold up to the standard of what you do inside of the hospital. If you did it just as the minimum that the state requires, I think that you could have the potential for some issues down the line.”
The other essential component of success in patient safety, and ultimately the success of the center overall, is case selection.
“That’s huge in cardiovascular because you’re dealing with a little bit of a sicker population [at] baseline,” Ms. Hagan said. “When you’re looking at the patients, you have to have a really good exclusionary criteria that you stick to and don’t start bending rules. Our exclusionary criteria is very clear, and if they don’t meet it, they don’t come to the ASC. It’s just too high risk. It’s high risk for the patient, it’s high risk for the facility.”
The hospital will always maintain its place as the most appropriate setting for high-risk cardiovascular patients, she added, while it’s likely that ASCs will continue growing as a more convenient, lower-cost option for those who do meet safety criteria.
“I do believe you’ll see a lot more cardiovascular ASCs popping up, and I think they have to prove themselves as safe, and they have to prove themselves as financially beneficial for the healthcare system as a whole,” Ms. Hagan added. “We’re trying to provide care at different locations to free up the hospital and to give the patients the experience they deserve based on their acuity — and then lower costs for the entire system overall.”
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