Key points to remember when performing cardiac ablations in ASCs
In 2025, the Centers for Medicare and Medicaid Services (CMS) finalized coverage for cardiac ablations performed in ambulatory surgery centers (ASCs) as part of its 2026 Hospital Outpatient Prospective Payment System and ASC Payment System final rule. The Heart Rhythm Society (HRS) and American College of Cardiology (ACC) then responded to that policy shift by releasing a new guidance for cardiologists performing those procedures in ASCs.[1]
Samuel Jones, MD, director of inpatient electrophysiology for the Chattanooga Heart Institute and co-chair of the guidance document, said the recommendations were developed due to growing interest from physicians, patients and payers.
“This is an important topic to our members, to our patients, and to the payers. And when you have all three of those groups that are interested in something, we knew we needed to come up with a document about it,” Jones told Cardiovascular Business at Heart Rhythm 2026. “Importantly, the document was not about ... advocating for or against ASCs. The goal was to make sure that if you do it, you do it with quality and safety in mind.”
The document follows a similar guidance developed for interventional cardiology procedures after CMS expanded ASC reimbursement for percutaneous coronary intervention. Jones said electrophysiology ablation presents a new set of considerations because these procedures historically have stayed in the hospital.
“We needed to make sure that we look at several different factors to make sure these are the things we want you to do. This offers some checklists that you need to have to make sure that you do it correctly,” he said.
Patient selection central to ASC safety
Jones said the guidance places patient selection at the center of decision-making for outpatient EP ablations.
“I think first and foremost, it is always patient selection. That's going to be making sure that you have a patient that doesn't have significant comorbidities,” he said. “If you have significant heart failure, they are decompensated, bad lung disease, bad liver disease, that might be a patient that you think should not go out to the ASC.”
Beyond patient selection, the document also addresses facility readiness, procedural appropriateness and physician experience.
“The facility needs to be definitely constructed in a way that it is ready for anything that happens, and have transfer agreements over to a main hospital,” Jones said. “There are procedures that you should not do there and there are some procedures that are probably better there.”
He also cautioned that operator experience matters as programs begin transitioning ablations into outpatient environments. Jones said you do not want to an electrophysiologist who only fresh out of fellowship; you want someone with experience.
Growth of ASC model driven by lower costs and need for more access
Jones said multiple factors have accelerated interest in ASC-based electrophysiology programs, including physician dissatisfaction with traditional hospital arrangements, the need for expanded patient access, and the fact that procedures cost less in that setting.
“We just don't have enough electrophysiologists right now to take care of all of those patients that are needing our services. So this provides another area in these very focused centers that can have patients come in streamlined and they can do it more efficiently than anyone else," Jones explained.
He said the COVID-19 pandemic significantly accelerated the acceptance of same-day discharge strategies after atrial fibrillation ablation procedures.
“In 2016, less than 1% of patients would go home the same day after an ablation for atrial fibrillation,” Jones said. “Fast forward to 2023, and it was 63%, and much of that was being driven by the COVID pandemic.”
Advances in technology in terms of new mapping and ablation systems also improved procedural safety and efficiency, helping support the transition to outpatient care settings.
ASC financial considerations require careful oversight
The guidance also addresses the increasingly complex business environment surrounding ASC development. Jones noted that establishing a new electrophysiology-friendly ASC can require millions of dollars in startup capital and extensive expertise in billing, coding and regulatory compliance. He said this may require physicians to seek partnerships with hospitals, management groups or private equity firms to help finance and operate the business side of these ASC programs. But he also emphasized that financial incentives should never drive clinical decisions.
“It can never be done for the financial reasons solely,” Jones said. “I think that electrophysiologists need to not be looking at what is the dollar sign."
He added that physicians considering independent ASC ventures must understand complex regulatory requirements that vary widely by state, including certificate-of-need laws and operational compliance issues.
Hospitals will continue to play a key role in EP
Despite the growth of outpatient procedural care, Jones stressed that hospitals will continue to play an essential role in electrophysiology care delivery, particularly for higher-risk patients and complications requiring escalation of care. ASCs also need to have agreements for transferring patients to area hospitals in case of complications beyond the scope of the ASC.
“We're not saying that all ablations or all patients should go to an ASC,” he said. “We need to understand that there's always going to be a role for the hospital and partnering with that hospital for many is going to be really important to do that.”
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]