The business of cardiology is changing—and cath labs are working to keep up
As cardiac catheterization laboratories take on more complex procedures and adopt rapidly evolving technologies, hospital leaders and interventional cardiologists are facing mounting financial pressures that threaten traditional care models. Nirat Beohar, MD, director of the cardiac catheterization laboratory and medical director of the structural heart disease program at Mount Sinai Medical Center in Miami Beach, outlined these challenges during a presentation at the TCT 2025, where he then spoke with Cardiovascular Business for a video interview.
“The cath lab is a very dynamic place in the hospital and it is also a big money-making part of the hospital,” Beohar said. “At the same time, the number of technologies that we offer to patients nowadays is rapidly increasing, which means that these procedures are getting more and more complex, more labor intensive, require more staffing, more imaging. And in that regard, also more costs.”
While procedural complexity and resource utilization have increased, Beohar noted that reimbursement has lagged behind. This creates what he described as an ongoing tension between delivering cutting-edge care and remaining financially solvent. Long, resource-intensive structural heart procedures raise questions about how to account for physician time, nursing and technologist staffing, imaging specialists and capital investments such as advanced imaging systems and image-fusion platforms.
“So now this is a tension between wanting to offer the best to the patients and the latest and the greatest technologies, and how do you compensate you and remain financially solvent offering all these technologies,” he explained.
Adding to that strain is the fact that the Centers for Medicare and Medicaid Services (CMS) is moving toward cost-neutral payment models. Under these policies, procedures performed in lower-cost outpatient or ambulatory surgery center (ASC) settings may receive similar reimbursement to those done in hospitals, despite significant differences in overhead.
“So then how do hospitals balance this versus an ASC, which is a freestanding outpatient facility?” Beohar said. “Do they partner with those? Do they create their own? Or how does that dynamic work?”
Beohar said institutions are taking different approaches to managing the gap between innovation and reimbursement. While some are willing to deal with the added costs because they want to offer the very best technologies and services, others are being forced to cut back on what they can offer.
Coding and documentation also emerged as a major theme. Beohar pointed to discussions held alongside a Society of Cardiovascular Angiography and Interventions (SCAI) session on appropriate CPT coding for complex procedures. The goal, he said, is to ensure hospitals are not “leaving money on the table that rightly belongs to the system."
These financial realities are fueling a broader push for business education within cardiology.
“Should medical students, for example, have an education in the business of medicine?” Beohar asked. “Because when they are out there practicing as full-fledged doctors, how are they going to be financially viable?”
He emphasized that financial literacy is no longer optional for physicians.
“If you're not financially viable, you can't function,” Beohar said. “The business education is probably just as important as learning a new procedure and how to do it well.”
As reimbursements continue to tighten and technology costs rise, Beohar said professional societies are responding with more training, sessions, and educational materials focused on economics and practice management. The goal is to help cardiologists balance fiscal realities with the imperative to deliver life-saving and life-improving therapies in an increasingly complex cath lab environment.
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]