There are more cardiovascular surgeries and procedures being performed in ASCs and ambulatory settings, and that movement is not expected to slow anytime soon.
The shift to outpatient care for cardiology has led to an increase in access to care, patient satisfaction and lower cost, according to one executive.
Kristen Richards, the vice president of ambulatory care at Cardiovascular Logistics, a national cardiovascular platform, recently connected with Becker’s to talk about the forces behind the shift and how to navigate the regulatory side of things.
Note: Responses were lightly edited for clarity and length.
Question: Why has there been such a big shift and increase in the amount of cardiovascular care that’s being performed in ASCs and outpatient settings, and what has driven that shift over the last couple of years?
Kristen Richards: Cardiovascular ASCs, I would say, are the new kid on the block. We’re certainly gaining momentum, and it’s really in line with providing greater access to our patients at large, in all the different communities. Having access to a lower cost setting and to take some of the burden off of the hospitals to be able to provide these lower acuity cases has really been something that has been a win-win for the patient. There’s just this shift and this movement. Not everybody’s aligned yet and we still have a ways to go here. We have some momentum here and there are some really good things that are happening in the ASC space, from a quality standpoint, that we’re now measuring and managing and reporting data to ensure that we’re driving quality metrics and quality outcomes of ASCs.
Q: Do you see that momentum continuing?
KR: I do, and I think part of that is going to be driven by payers, because they’re going to push the patients to these lower-cost settings to provide care that is as equal as doing it in the hospital. The care being delivered in the ASCs is demonstrating that the quality metrics and the patient experience in the ASC outperforms the hospitals. Patients are just thrilled to come into this space, because it’s easy to get to and it costs less money. They’re in and out. They can be home for lunch. There’s a lot of efficiencies that are gained in this space. I do see that we’ll continue to see growth in this area, and we’ll continue to see payers push in this area as well. We’re seeing it in the fact that CMS is adding procedures every year to the covered procedure list to be allowed in the ASCs.
Q: How are you navigating the regulations and hurdles to opening new ASCs?
KR: It is different for every state. We currently have three ASCs that are opening by the end of this year, one in Illinois, one in Florida and one in Pennsylvania. They all have their different regulatory requirements, specific things that you wouldn’t see in Illinois or in Florida play out but do in Pennsylvania. We have to pay close attention to that, and we are absolutely thrown curve balls occasionally, where we have to pivot and adjust.
For example, our new ASC in Illinois has had some delays because of the joint venture. There are now new regulations that are now going to apply to this ASC, and this was news to us. We found out in the last few weeks, so now we’ve had to start working with other companies and organizations to help us meet those regulatory requirements, like reporting or accreditation, and those are additional costs. You’re adding additional expenses, but those are things you just have to be willing to adjust as appropriate to meet the needs of your regulatory partners.
Q: Once ASCs become even more mainstream, do you anticipate any federal oversight to make opening a new facility more streamlined?
KR: I do actually think that will happen. I’m already starting to see that, and it’s because CMS is requiring reporting from the ASCs from a quality metric standpoint, as well as from a patient experience. We’re now having to report those on a quarterly basis. In the future, ASCs will be penalized, just as hospitals are for their performance. You’ll either be penalized or incentivized on your performance. So I do see some of those barriers coming down, and we’re already seeing it across the country, particularly when it comes to certificate of need requirements. We still have quite a few states that have certificate of need laws, but in many cases people are petitioning to take those barriers away. It takes a monumental effort to actually open a new ASC because of some of the barriers that are in place today from a regulatory standpoint.
