Society of Cardiovascular Angiography and Interventions (SCAI) President Sunil Rao, MD, spoke with Cardiovascular Business at ACC.23 about the shift in interventional procedures from hospitals to less expensive ambulatory surgical centers (ASCs). Rao also serves as the director of interventional cardiology at NYU Langone.
This movement to ASCs has been spurred by the Center for Medicare and Medicate Services (CMS) providing favorable payments to these types of outpatient cath labs because they can usually perform the same procedures in low-acuity patients at half the cost of a hospital-based cath lab. ASCs are reimbursed for low-risk procedures such as diagnostic angiograms, peripheral artery disease (PAD) revascularization, straightforward percutaneous coronary interventions (PCI) and electrophysiology (EP) procedures like pacemaker and ICD implants or replacements.
In 2020, soon after CMS approved reimbursement for PCI in ASCs, SCAI developed a position statement on the performance of PCI in ambulatory surgical centers that provides guidance for starting a PCI program in an ASC with an emphasis on quality standards, regulatory requirements, and standards for the facility, staff and physicians.
"SCAI wants to improve the quality in cath labs regardless of where patients are getting their interventions or diagnostic cath. We don't really take a position if an ASC is the right thing to do or the wrong thing to do. We know this is happening and we know there is a push on the part of CMS to more outpatient kids of procedures largely because it is a cost saving measure. Our goal is to make sure quality and safety are maintained," Rao explained.
He said the position statement offers a template for how to manage interventional quality standards in an ASC.
"It is going to be a really exciting space, because there are now 23 states that allow PCI in ambulatory surgical centers, and I suspect that is the direction the world is headed," Rao explained.
Private-equity firms are also interested in investing in ASCs because they feel this is the future of easy PCI and other types of interventional and EP procedures. He said this is in part because hospitals are currently facing a large volume of cases, partly due to a COVID-19-related backlog of deferred cases, and are looking for additional bandwidth without the need or expense to build out additional cath labs.
"I think all of us who work in a hospital setting have noticed that our hospitals are jam-packed," Rao said.
He also noted ASCs may be one way to accommodate that additional volume.
SCAI's main concern is that these outpatient centers, often run by private companies and not health systems, are held to the same standards as hospital cath labs in terms of patient safety and the quantity of care and outcomes their receive. One way to track quality is through the creation of registries to collect data that can be compared and contrasted to hospital cath labs. The American College of Cardiology (ACC) is currently working on a paired down version of its National Cardiovascular Data Registry (NCDR) for cath labs to make it easier for ASCs to participate.
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: dfornell@innovatehealthcare.com