Cardiology is following orthopedics, urology and other specialties toward the ASC, but it’s just on a longer timeline.
Gary Kirsh, MD, the new CEO of national cardiology platform Cardiovascular Logistics and co-founder of Solaris Health, the largest urology-focused MSO in the country, is already acting on that shift: CVL is opening multiple new ASCs this year and aims to have one at nearly every site in its network.
He spoke with Becker’s about cardiology’s move to outpatient settings, why he still thinks it’s inevitable and where CVL is focused on growth.
Note: Dr. Kirsh’s answers were lightly edited for clarity and length.
Question: How is the removal of cardiology procedures from the Inpatient-Only list shaping your strategy? What are some of the challenges of moving some of these complex cardiovascular procedures to outpatient settings?
Dr. Gary Kirsh: Some of this care was already done in an office-based lab, so physicians are used to that. The more intense procedures, particularly the vascular procedures and the electrophysiology procedures with ablations, are more complicated.
What are the barriers? First, you have to have ASCs up and running, and that takes a while, plus they’re expensive to build. You need specialized doctors who are very capable in these areas, and you need specialized equipment. Those stars all have to align.
Then there’s the physician workflow. I’ve built ASCs in a different specialty, and you have to change how physicians operate. They have their schedule set, they want to be at the hospital at a specific day and time to make their rounds and do cases, so you have to re-engineer their schedules to get them to a different facility. It’s not always convenient.
However, it’s an opportunity for excellent patient care. It’s more convenient for the patient, more tailored to their needs, and it’s a lower-cost site of care. It’s an opportunity to create regional centers of excellence, clinically and for the business, and to protect physicians’ ability to stay independent. Are there barriers — building them, getting the right doctors, training, acceptance, schedules? Yes. Will it happen? Yes.
Q: Are those challenges worth the necessary time and investment to reap the long-term rewards?
GK: It is not the same investment as a simple machine you put in your office. They are capital intensive. They are schedule disruptive. They’re a big, big project, but you see them all over the country flourishing in multiple specialties, and that will happen in cardiology. It just takes time. We’re opening two this year, and we’ll have an ASC in each of our sites except New York due to the regulatory environment. We’re also looking to see if we need a second ASC anywhere, and when we do go into the M&A space, ASCs will definitely be part of the equation.
Q: When it comes to growth opportunities, where are you focusing? What is your strategy when it comes to expansion?
GK: We want to do more expansion, because scale matters in this business. The problem in cardiology, unlike urology, is that there are fewer independent groups left to approach. Cardiologists took a hit about 15 years ago by a stroke of the pen from the government: changes to imaging reimbursement pushed them all into the hospital, and they’d been independent up until then. But the pendulum is swinging back now, with the shift to the ASC and increasing site-neutral payment leveling.
When it comes to the M&A, because there are fewer groups to approach than in some other specialties, you have to approach those that are out there. You then have to decide: Are they in a good market? Do they have good cohesion? What services do they have now versus how can we help them gain services and increase their growth? So all those things are a factor.
In general, yes, we do want to grow by more groups. We particularly would like to grow in the West because right now we are mainly Northeast, Southeast, and a bit in the Midwest. As far as inorganic or organic growth goes, we have a lot of opportunity to do the right thing for patients and doctors in this space in this specialty.
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.
