Cardiologist highlights key differences between OBLs and ASCs

OBLs are typically owned as part of a medical practice, operating under the same license or tax identification number as the physician group. He said these labs commonly perform diagnostic catheterizations, peripheral interventions and vein procedures outside of the hospital.

In contrast, ASCs are able to do a wider range of procedures and more complex cases as independently licensed entities. However, they are much more regulated at the federally and state levels.

“They can do low-risk PCI, they can do all complexities of vascular work. They can even do pacemakers, defibrillator, implants, etc,” he said.

Reimbursement differences compared with hospitals are a major driver of interest in both models. Pancholy said payers benefit because OBLs and ASCs are reimbursed at lower rates than hospitals, but these outpatient centers have much lower overhead costs.

Physicians often become partners in these businesses, which can offset lower per-case reimbursement.

Hospitals are increasingly entering joint ventures with ASCs. Hospital expertise in regulation and access to capital make it very attractive for physicians to sign on. Health systems are using ASCs as a way to offload lower-acuity cases while preserving inpatient capacity for more complex and higher-reimbursement interventions.

“If you don't do those five normal catheterizations, but you do two or three structural cases, that might bring in more revenue and enable better lab utilization,” Pancholy explained.

Despite the financial upside, Pancholy cautioned that outpatient models introduce business and legal complexities unfamiliar to many physicians. Liability concerns often come up when discussing these facilities at industry conferences and during other group settings.

“This is not what you get taught in medical school,” he said. “This has to do a lot with numbers, reimbursements, negotiation skills and regulatory knowledge."

Quality and safety of outpatient labs also remain central concerns, but Pancholy said evidence increasingly supports comparable outcomes across settings. He added that outcomes are largely driven by the experience, skills and judgement of the interventionist. ASC regulations require formal patient transfer agreements with hospitals in case there are complications.

With patient convenience, payer pressure and capacity constraints all favoring outpatient growth, Pancholy said expansion is inevitable. 

“It's going to grow whether we like it or not,” he said. “And our goal as the medical community is to make sure the quality and the patient's outcomes don't degrade.”

Hear more insights from Pancholy in the video.