Cardiac catheterization has been experiencing a revolution, following other service lines in their shift outside the walls of the acute care hospital. More than 1 million times a year, cardiac cath plays an essential role in the diagnosis and treatment of the leading cause of death in the US – cardiovascular disease.
Not that long ago, these procedures in the US were performed only in hospitals with onsite open-heart surgery available as a backup. Following extensive study and recommendation from national organizations, CMS approved caths to be performed in hospitals without onsite open-heart surgery capabilities, which greatly improved patient access. Then starting in 2019, CMS went further, approving reimbursement for cardiac cath in freestanding facilities.
Today, appropriate outpatient diagnostic and interventional cardiac cath procedures are increasingly being performed in ambulatory surgery centers (ASCs) across the country, especially in states without CON regulations. A number of CON states in the southeastern US have been generally more cautious, with the pace of cardiac ASC approvals picking up in just the past two years.
This is largely a positive trend, not only for benefits to the patient experience but also because lower costs in the ASC setting – often around 50% lower – can help “bend the curve” on rising healthcare spending
For all of the positives, it’s true that lower reimbursement rates for cardiac ASCs can create some hospital revenue challenges. But in markets that have greater competition or independent cardiologists who prefer the relative autonomy of an ASC, health systems may find they have little choice.
The migration to ASCs is a pattern we’ve seen repeatedly with other ambulatory-sensitive conditions, and we anticipate more health system and physician groups will move in this direction for cardiac cath.
One Client’s Experience
Over the last few years, Ascendient has helped clients in North Carolina, Virginia, and Mississippi with business planning and CON applications for these cardiac ASCs.
One of our most recent clients, Bon Secours Mercy Health (BSMH), was awarded a Certificate of Public Need (COPN) in December 2023. Partnering with Compass Surgical Partners, BSMH is developing a cardiac ASC to serve a key market in Virginia – the greater Richmond area.
We spoke with Ryan Stuhlreyer, VP of Service Line Strategy at Bon Secours Richmond Health System, to get his take on this significant and innovative change in cardiac care. (The following interview has been lightly edited for clarity and length.)
LAB: What are the greatest benefits to patients being provided access to cardiac cath services in a freestanding setting?
RS: I think the ability to really build it and model it around the patient experience. We do a strong job in the hospital, but to have a center purely dedicated to this service day in/day out is significant. We can bring our experience and quality from the hospital, as well as the staff dedicated to these services. This is taking a piece of the hospital and putting it in ambulatory setting that is focused on this type of care.
LAB: Are there benefits to providers and staff – particularly any that are relevant to recruitment efforts?
RS: For the staff, it’s the ability to work with the same providers every day and focus their skillset on a core set of procedures. For someone who loves cardiovascular care, this is it for them.
From a physician standpoint, it’s the specific, closed environment and the ability to have greater ownership of the center – not necessarily even the ability to be a part owner, but rather the ability to be more involved in all aspects. While there is a similar approach in the hospital, there is also a level of deferring to hospital leadership that occurs, which is less [pronounced] in a dedicated freestanding center.
LAB: What is significant about the shift of appropriate outpatient cardiac cath procedures to the dedicated freestanding setting from a cost perspective?
RS: From the payer perspective, there are definitely economic benefits to a freestanding center, and it is a differentiator for the health system, as well. Having a center that is focused on a specific service or clinical area tends to enable economies of scale, less wasting of resources, and improved efficiencies.
LAB: What would you say to those who may think there are safety concerns about this change in the model of care?
RS: I would say every patient is thoroughly vetted from a clinical standpoint. The physicians are in the driver seat in this model. Physicians have created the clinical protocols and guidelines.
Advances in clinical technology and techniques have made it possible for these procedures to be performed in the freestanding setting. There are also safety mechanisms in place, ranging from oversight to transportation. It’s a very safe environment for procedures approved to be in this setting, as demonstrated by successful models in other parts of the country … but patients can always request the procedure to be performed in the hospital setting [if they prefer].
LAB: Do you anticipate the pace of the shift to the freestanding setting to escalate or continue at the current pace? And why?
RS: Escalate. A lot of people were watching our COPN cycle, which also had a competing applicant (a local physician group). There has already been another application this year, and we expect to see more of these across Virginia – by health systems and physician groups. Large cardiology groups in general seem to be exploring moving a range of other services to the office-based setting. We’ve seen this trend among non-cardiology groups for years and now it’s coming to cardiology.
LAB: You chose to partner with a company to help develop and manage the ASC. Why was that important to you?
RS: Any time you choose a partner it’s important to have the same vision. Compass brings great experience and talent among their team. Sometimes systems don’t scale as fast as we should. We know there is a paradigm shifting care to the ambulatory setting. As a result, it’s strategically important to add to our portfolio a partner that can help us achieve this. They bring scale and experience to business and clinical plans in this space.
LAB: Anything else that excites you about this model that you’d like to share?
RS: We are the first health system in central VA that has embraced this model. I’m excited about the clinical leadership that is a part of this project. We still have a runway before our center opens, but there has already been a lot of involvement among the physicians on bringing this model to fruition in a safe and patient focused manner to improve care and be on the leading edge.
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