What the rise of outpatient cardiac OBLs and ASCs means for cardiology
To reduce the healthcare costs associated with straightforward, minimally invasive cardiovascular procedures, more and more ambulatory surgical centers (ASCs) an office based labs (OBLs) are opening all over the United States. These outpatient centers can often perform the same procedures as hospital-based cath labs at about half the cost.
Cathie Biga, vice president of the American College of Cardiology (ACC) and president and CEO of Cardiovascular Management of Illinois, explained this rise in OBLs and ASCs in a new interview with Cardiovascular Business.
"There is no doubt that we need to have lower-cost alternatives, and OBLs and ASCs are two of those, and they are absolutely here to stay. We need to be able to deliver care in the least expensive environment safely and appropriately," Biga explained.
These outpatient treatment centers offer higher rates of both provider and patient satisfaction, Biga said, in addition to delivering high-quality outcomes in a lower-cost setting. Medicare began reimbursing for ASC basic percutaneous coronary interventions (PCI) in 2020, which accelerated the growth of these centers. Regulations in some states favor OBLs or ASCs, so there has been a concentration of these centers in some states, mainly in the band from Florida across to country to the west to Arizona.
In some cases, larger hospital systems are even partnering with private companies that manage these labs to outsource their less complex cases and make room in the hospital cath labs for more involved (and more lucrative) procedures.
Biga said the Medicare fee schedule has changed in recent years to favor these outpatient centers for lower acuity patient care because they have much lower overhead costs than large hospital systems. The shift is being made for similar financial reasons as the shift over the past decade from private cardiology practices to cardiologists increasingly being employed by the hospitals.
"There is a financial element to that you can't ignore, and the same is true here," Biga explained.
In many cases, OBLs and ASCs have the same equipment and often they have the same cardiologists at the area hospitals performing these procedures. She said the difference is just the location, which changes how much a procedure is reimbursed and how that translates into revenue when there are not a large number of additional costs that hospitals have to cover.
"Outcomes are probably just as good, if not better, and patient satisfaction tends to be much better because it is an easier in or out. If you go to a hospital and your are registering, it is a two-hour process. If you are in a smaller setting, it is a much better patient experience," Biga said.
Her biggest concern with these centers is that they meet the same patient safety and quality metrics as hospital facilities. Biga said this can be done if OBL and ASCs become a part of the ACC National Cardiovascular Data Registry (NCDR) like larger cath labs at hospitals. She said this would provide a benchmarking capability to measure the quality of the outpatient centers as compared to traditional care for similar types of patients and procedures. The ACC is presently working on a lighter version of the registry to support OBLs and ASCs.
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