The last year has seen a whirlwind of developments in cardiology as more procedures shift towards the outpatient setting, spiking interest from ASC leaders and other healthcare stakeholders.
However, despite the high potential for growth in the space, some leaders say that outpatient cardiology still faces numerous challenges.
“There are quite a few, to be honest,” Kristen Richards, vice president of ambulatory care at Cardiovascular Logistics, a physician-led cardiology platform, told Becker’s. “Cardiovascular ASCs are still the new kid on the block — migration has been a little slower.”
She said that reimbursement has been a significant issue as both CMS and private payers’ reimbursement rates continue to lag behind the outpatient migration in many specialty.s
“Reimbursement is definitely lower in this space — about 53% lower than a hospital outpatient department,” Ms. Richards said.”That can be challenging if you’re not operationally efficient and focused on leveraging your organization to get better pricing. Financial sustainability can be tough.”
Alignment between Medicare and private payers specifically remains a challenge. Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, told Becker’s last year that the biggest payer issue his ASC is facing is “denials that do not fall in line with the Medicare payable procedures.”
Many private payers aren’t matching Medicare codes for cardiology procedures, Mr. Helmer said, “For example, loop-recorder implants are commonly denied for no prior authorization from private payers, yet, in the Medicare fee schedule, they require no authorization and there’s usually not a problem.”
On Nov. 3, CMS released its 2025 physician fee schedule final rule, which increased the conversion factor for qualifying practitioners by 3.77%, which includes changes passed in the “One Big Beautiful Bill Act” earlier this year, according to the American College of Cardiology. The ACC estimates that the finalized proposals will increase payments to cardiology by 1%, but this largely depends on patient and service mix as operational and infrastructure costs in the space remain high.
“The cost of setting up a cardiovascular ASC is also significant because of the complexity of the equipment,” Ms. Richards said. “Outfitting a single room can cost well over $1.5 million.”
Certificate-of-need laws also present an obstacle, as many CON laws predate the outpatient migration of cardiology and can be burdensome to navigate. Ms. Richards told Becker’s that “about 50% of states still have certificate of need laws that restrict [percutaneous coronary intervention] or complex interventions, which creates barriers for outpatient migration.”
Cardiology’s expansion into the outpatient space is also changing the status quo for hospitals, who traditionally have been the primary site-of-service for cardiovascular procedures.
“Cardiovascular procedures are among the top revenue generators for hospitals, so this shift can be difficult for them,” she said.
Hospitals, she said, risk losing margins as high-volume cardiovascular cases move to the outpatient space. However, she noted that hospitals can offset those losses by focusing on higher-acuity, complex procedures that remain inpatient-only.
“It’s critical that hospitals partner closely with their physicians, embracing this transition as ‘right patient, right procedure, right facility,'” she said.
“That’s why we focus on being good partners — aligning with hospitals to ensure we’re doing this for the community,” she continued. “We’re moving lower-acuity cases outpatient, but hospitals will continue to care for higher-acuity patients. That partnership can also help relieve hospital capacity issues — many are stretched thin with bed shortages and staffing challenges. I like to say, ‘You’re either at the table or on the menu.'”
Looking ahead, cardiology is likely to find its place among a growing array of new ownership models, including joint ventures between hospitals, ASCs and physician groups and other hybrid models between healthcare organizations and financial backers or technology companies.
