More interventional procedures may be coming to an ambulatory surgical center near you
Ambulatory surgical centers (ASCs) and office-based labs (OBLs) are poised to play a growing role in cardiovascular care as payment policies shift and health systems look for more efficient ways to manage procedural volume. That trend, and the guardrails needed to ensure patient safety, was the focus of an educational session at TCT 2025 in San Francisco.
Cardiovascular Business spoke with one of the presenters, Arnold Seto, MD, cath lab director at the Long Beach VA Medical Center, professor of medicine at Charles Drew University, Society for Cardiovascular Angiography and Interventions (SCAI) treasurer and chair of the SCAI Advocacy Committee, to find out more.
Seto said there is wide expectation that lower-acuity interventional cardiology and peripheral procedures will migrate into the ASC environment. This is partly due to better cost effectiveness and the fact that larger centers want to expand into more complex and structural heart procedures without building out their hospital cath labs to be bigger.
“The consultants tell us that as many as 25% to 50% of cardiology procedures will be migrating to the ASC environment. The government would prefer that because they pay about two-thirds of the hospital outpatient costs compared with an ASC reimbursement,” he said. He added that the Center of Medicare and Medicaid Services (CMS) is clearly signaling interest in this shift. “We’ve already seen CMS effectively remove all the PCI codes from the inpatient only list, and actually talk about removing everything from the inpatient only list.”
While only 1-2% of percutaneous coronary interventions (PCIs) are being done in ASCs today, Seto emphasized that much more growth is coming.
"That's where people are moving to. I still don't think it's going to be nearly as fast as what the consultants think, but it just needs to be thought out very well," he said.
In years past, there were big concerns about the quality of care delivered in OBLs and ASCs because of the lack of oversight and quality control. But this has changed over the past couple years as professional societies have created guardrail policies and accountability through national data registries. The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) is now tracking ambulatory surgical centers and trying to keep the quality level higher. Seto said the Outpatient Endovascular and Interventional Society (OEIS) also started its own very extensive registry to track quality of care. He added that SCAI is also creating guardrail policies to guarantee quality of care and safety in these labs are held to the same level as hospital cath labs.
“I think it's changing from the sort of a Wild West mentality when there's no registry. Now the NCDR is getting involved, OEIS has started their own registry and SCAI is getting involved,” Seto said.
SCAI has seen growing interest in ASCs from private practice physicians who want to maintain autonomy as well as health systems looking to off-load low-acuity cases to outpatient settings. SCAI is partnering with consulting firm Corazon to help practices navigate the business and regulatory complexities of starting an ASC. Seto said it is important to have a solid business plan in place for these ventures, because there is a lot involved.
"You need a partnership with other physicians of different specialties, and the business manager to make sure you don't lose your shirt. But the opportunity is there, the autonomy is potentially there and you just need to make sure the details work for everybody," Seto explained.
State ASC regulations make outpatient labs attractive
States regulate these outpatient centers. As more states expand their ASC capabilities, some health systems and cardiology groups are already restructuring care delivery. Seto noted a few regional growth hotspots.
“We're seeing it most in Arizona with partnerships with health systems like Banner Health and in the Las Vegas area and Florida,” Seto explained.
He added that ASC and OBL ownership models are shifting, with physicians increasingly entering partnerships with hospitals.
“It's interesting to see this evolve. Physicians like ASCs because it gives them more autonomy over their practice. They get to hire and fire and control the flow, and that's part of what makes ASCs more efficient than hospitals.”
Physicians see more autonomy in ASCs
That efficiency comes with boundaries, he said. For example, ASCs do not manage the sickest cases or provide standby capacity. Still, ASCs may help expand community access while supporting physician engagement.
“As a whole, the professional societies are supportive, understanding that there is this big pressure from CMS to also reduce costs,” Seto noted.
For some cardiologists, ASCs may provide a new avenue for autonomy after a decade of consolidation in the specialty. Ten years ago, private cardiology practices made up 90% of the cardiologist employment model in the U.S., but today they only make up 10%, which the vast majority of cardiologists now employed by health systems.
Set said many employed physicians feel like they are "just another skilled laborer that's replaceable,” but ASCs can restore a sense of ownership.
Seto emphasized that the sector is still in its early stages. Growth will require a careful balancing of safety, cost and professional autonomy, but momentum is undeniable.
“The opportunity is there, the autonomy is potentially there. It's just making sure the details work for everybody,” he 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]