Banner Health partnering with physicians to bring more heart procedures to ASCs
Banner Health is expanding the use of co-owned ambulatory surgical centers (ASCs) in the Phoenix area to shift lower-acuity electrophysiology (EP) and interventional procedures out of the hospital. The goal is to free up hospital capacity for more complex cases while potentially reducing costs.
Wilber Su, MD, director of cardiac EP at Banner Health and a professor of medicine at the University of Arizona, said Banner has developed ASC partnerships with private physicians and more recently established an academic ASC model in which employed physicians can participate. The approach reflects a broader trend toward performing selected cardiovascular procedures in outpatient settings.
Recently, the Centers for Medicare and Medicaid Services (CMS) began covering EP cardiac ablation procedures in ASCs. Su said advances in EP technology have made procedures such as atrial fibrillation (AFib) ablation substantially shorter and more predictable than they were two decades ago, which ensures the safety needed as an outpatient procedure.
"AFib ablation used to be a complex four to six hour procedure when I started 25 years ago to now is a one hour procedure," Su said in the above video interview with Cardiovascular Business. "So it really makes sense that we're kind of catching up to the point where we say, why shouldn't this be done in the daytime surgical center?"
ASC model can help hospitals create more capacity
For hospitals, the model is less about losing cases than creating additional capacity. At Banner's University Medical Center in Phoenix, hospital EP labs frequently handle high-acuity patients, including ventricular tachycardia and complex redo procedures. When those labs are full, lower-risk cases are often be delayed. Su said an ASC can provide a parallel pathway for straightforward procedures, allowing hospitals to preserve their most valuable lab space and staff for patients who require hospital-level resources.
The same principle applies to interventional cardiology and structural heart procedures. As transcatheter aortic valve replacement and other complex procedures occupy more cath lab capacity, Su said, hospitals need to distinguish procedures that require the hospital from those that can safely be performed elsewhere.
“If you're in the middle of that and you have to say, I'm going to do a heart biopsy that's elective, it slows everything down,” he said. “The value of the space in the hospital really needs to go to the high acuities.”
Banner, physicians and ASC management company all have a stake
Banner's ASC ownership model gives physicians a direct financial and clinical stake in the facilities. In the arrangement described by Su, physicians hold 49% ownership, while Banner Health and an ASC management partner, Atlas, share the remaining ownership.
That structure combines Banner's existing commercial payer contracts with the management partner's experience in ASC operations, equipment and contracting. Physician ownership, meanwhile, helps align incentives around safety, quality and outcomes.
Clinical governance remains important. Su said physicians participate on a board that establishes credentialing requirements. For example, physicians performing AFib ablation must be comfortable managing potentially serious complications such as cardiac tamponade requiring pericardiocentesis.
However, Su cautioned that building a financially sustainable ASC requires considerably more than moving procedures out of a hospital. Reimbursement contracts are a major consideration, particularly as newer technologies such as pulsed field ablation increase equipment costs. A physician group may discover that commercial reimbursement for an AFib ablation is below Medicare rates, making it difficult to cover equipment, staffing, facility and other costs. Initial capital investment, vendor contracts, staffing and maintaining adequate procedure volume also must be addressed.
For that reason, Banner chose to work with a company specializing in ASC management rather than operate the facilities entirely on its own.
“Banner is a great hospital company, but they're not an ASC company,” Su said, noting that day-to-day ASC operations require specialized expertise in staffing, scheduling, equipment and workflow.
The ASC model with a management company also frees up the physicians to do patient care rather than administrative work, he said.
Su explained the model can give physicians greater control over the patient experience, from check-in and nursing care through recovery and follow-up. He described the ASC as a setting where physician owners can tailor care and develop a more personalized experience than may be possible within a large hospital.
As more cardiovascular procedures migrate into outpatient settings, Su said the key question is not simply whether a procedure can be performed safely outside the hospital, but whether the clinical, financial and operational pieces are aligned to make the model sustainable.
“I think it's a great way for the hospital to collaborate with physicians, to be partnered in providing the best of care,” Su said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]