When CMS announced in 2025 that it would begin covering outpatient cardiac ablations in 2026, Sheetal Chandhok, MD, knew what he wanted to do. The electrophysiologist at Bryn Mawr (Pa.) Medical Specialists Association told Becker’s that he had already spent years building a freestanding cardiac ASC, and ablation was the next logical step. The challenge was compressing what might have taken years into roughly eight months.
“We didn’t want to sacrifice safety from going to the hospital to a surgery center, and we certainly didn’t want to sacrifice the outcomes,” Dr. Chandhok said. “We wanted to be as good or even better in terms of success rate and safety rate.”
The center performed its first ablation in March. It has since completed more than 75 procedures, approximately 90% of them for atrial fibrillation.
Dr. Chandhok traces the eight-month buildout to three parallel tracks: patient safety and selection, staff training, and equipment acquisition.
“The No. 1 focus was patient safety, and then No. 2 was patient outcomes,” Dr. Chandok said. The team developed clinical guidelines covering which patients to include and exclude, incorporated frailty scoring and held ongoing discussions about the types of cases the anesthesia group felt comfortable taking on.
Bringing BMMSA’s anesthesia group into the planning process early proved essential. Rather than presenting them with a finished protocol, the center gave the anesthesia team a seat at the table when the protocols were being written, including decisions about which medications to keep on formulary.
“We gave them power upfront to help write some of the protocols of what they were comfortable [with] and not comfortable,” Dr. Chandhok said.
Because electrophysiology work was new to most of the center’s nurses and technicians, the team turned to industry partners for support.
“There was a lot of online training coursework, there was hands-on training, and industry [partners were] very helpful with that,” he said. “We even did heart dissection and things like that to really get them up to speed, so they felt very comfortable on day one.
Equipment acquisition presented a different kind of challenge. Unlike a hospital system with large capital reserves, a private practice ASC has to stretch its purchasing power. Dr. Chandhok said the center worked directly with vendors to structure payment arrangements that allowed the center to acquire equipment on par with what it had in the hospital setting.
“Most agencies don’t have millions of dollars of capital just to outlay like a hospital system does,” he said. “But you need to work these kind of strategic partnerships — how can we afford this, and how can we stretch out payments — and we don’t want to sacrifice on the products we’re getting.”
With equipment installed and protocols written, the center submitted for state approval in January. Reflecting on the timeline, Dr. Chandhok said the most important lesson had nothing to do with equipment or guidelines. It was about how a physician has to lead differently when building a system from the ground up.
“I’m a physician, and I want this done yesterday,” he said. “But you know, if you take that mentality and the impatience of most doctors, you’re not going to get it done.”
The work of actually running an ablation procedure depends on a team that physicians rarely see in full when they’re doing high-volume clinical work.
“As much as we think the doctors are the main part of this, the main part of this really is the nursing and the pre- and post-[procedure] staff,” he said. “Unless everybody else on that team does their part, the physicians cannot do their part. You need a good team, and you need a team who’s willing to share their experiences and ideas, and you have to be open in communication, and you can’t discount what they have to say.”
The center is now approaching its 100th ablation. Dr. Chandhok said the efficiency gains in the ASC setting have been immediate. He has gone from performing five ablations per week in the hospital to seven or eight in the freestanding center.
“This is one place that’s geared to do one thing, and do one thing very well,” he said. “Everything is geared in and out — from the time they get into the room, time to get out of the room.”
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.