Cardiology in Ambulatory Surgery Centers: Growth Potential and Strategic Considerations

Cardiology in Ambulatory Surgery Centers: Growth Potential and Strategic Considerations

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In recent years, the discussion around performing cardiology in Ambulatory Surgery Centers (ASCs) has intensified, with many ASC leaders viewing cardiology as the industry's next major specialty.

While Cardiovascular Ambulatory Surgery Centers (CV ASCs) hold significant growth potential, certain roadblocks can impede their development.

In this blog, we'll break down today's landscape and growth potential for cardiovascular (CV) surgical care in ASCs and provide insights on crafting an effective ambulatory cardiovascular service line strategy.

Cardiology in ASCs: Growth Trajectory

Heart disease stands as the foremost cause of death in the US. Tallying up the cost of healthcare services, medications, and productivity losses due to illness and fatalities, heart disease incurs over $200 billion per year.

However, the cost-effectiveness of the ASC setting presents a win-win scenario for CV patients, physicians, and payers alike. Patients benefit from enhanced outcomes at reduced costs, physicians enjoy a streamlined care delivery model, and payers witness improved efficiency at a lower cost.

Today's Cardiovascular Ambulatory Surgery Centers (CV ASCs) primarily conduct low-risk cardiac procedures like coronary interventions (PCI), catheterizations, or implants. Approximately 66 percent cath lab procedures can currently be executed in ASC settings, encompassing diagnostic catheterizations, percutaneous coronary interventions, cardiac device implants, and peripheral arterial interventions.

While many of these procedures still occur in hospital outpatient departments (HOPDs), industry experts suggest that by 2030, over 80% of cardiovascular procedures performed in HOPDs will transition to ASCs.

Cardiology Cost Considerations for ASC

Executing cardiology procedures in outpatient settings entails substantial upfront investments in equipment and infrastructure. ASC leaders must meticulously plan finances, including a comprehensive cost-benefit analysis and return on investment assessment.

Compiling a pro forma financial statement delineating the costs involved in establishing a cardiology center is crucial. For example, an ASC planning to expand an existing facility may spend $1-2 million if adding additional procedures and operating rooms, and a de novo cardiology focused ASC will likely require a more substantial investment.

Additionally, conducting a return on investment analysis, factoring in projected revenue, growth, profit margins, and exit strategies, is vital for informed decision-making.

Negotiate Effective Managed Care Contracts

Most cardiology procedures yield significant reimbursements per case, presenting ASCs with an opportunity to bolster top and bottom lines and equity value. However, ASC stakeholders should realize these gains require meticulous planning within payer contracts.

Effective managed care contract terms ensure your procedures are covered at rates that make the best financial sense for your business. To evaluate if your contracts are effective or require renegotiation, make sure you have complete existing contracts, with all crosswalks, fee schedules and amendments. Review those contracts thoroughly to ensure you are billing correctly and getting paid correctly. Look at the full case as it will adjudicate. With a full case analysis, you have the data to prepare a strong argument when negotiating new contracts.

Additionally, managed care contracts not only affect revenue, but the entire revenue cycle. To ensure you get paid what you're owed on each procedure, every staff member along the revenue cycle should understand the basics of your managed care contracts: payer policies and procedures, timely filing details, days to pay claims, appeal rights, and all applicable details related to patient registration.

Assess Market Opportunity and Competition in Cardiology

CV procedures are significant revenue generators for health systems. It's been estimated that 70% of cardiologists are employed by hospitals, but some healthcare systems are closing or cutting service lines due to declining patient volumes and escalating costs. This trend may present an opportunity for ASCs to expand their offerings and attract skilled cardiovascular specialists to the outpatient setting.

To assess your ASC's market opportunity and competition, evaluate the ASCs, cardiologists, and cardiology practices in your area and research surgeons or groups that could potentially join your ASC. Leveraging lower cost advantages of conducting cardiology procedures in outpatient settings could also help ASCs in rural areas cater to underserved populations and fill voids left by hospital closures.

Lastly, you should consider your referral base: do you have the resources to develop a strong patient outreach plan to recruit qualified CV candidates to your ASC?

Follow Clinical and Regulatory Developments Impacting CV ASC Revenue

Evaluate the cardiology procedures that both private payers and Medicare cover for the ASC setting and stay updated on changes that could impact revenue.

For example, in the 2024 OPPS Final Rule, CMS did not have any cardiovascular changes to the Inpatient-Only List (IPO) or the ASC Covered Procedures List (CPL). However, there was a payment update for Cardiac Positron Emission Tomography (PET)/Computed Tomography (CT) Studies. CPT code 78431 had a reduced reimbursement (back to the 2022 rate), but there wasn't any change to 78433.

While CMS may cover certain cardiology procedures, your state might not. Each state has different regulations and can impose restrictions. Be sure to stay updated on regulatory barriers, clinical protocols, and best practices for CV procedures in your state

Final Thoughts on Cardiology in Ambulatory Surgery Centers

ASCs can play a pivotal role in expanding access to high-quality cardiology care in the outpatient setting, driving positive outcomes for patients, physicians, and healthcare stakeholders alike. However, developing an outpatient cardiology facility or adding cardiology to an existing practice requires extensive planning and number-crunching. Take the time to focus on business development, contract management, and revenue cycle management to realize the maximum return on investment for your facility.

When you add cardiovascular procedures to your service line, you may also want to consider benchmarking your facility's care and compare outcomes with similar facilities. For example, the American College of Cardiology's National Cardiovascular Data Registry (NCDR^®) recently launched the NCDR CV ASC Registry Suite, allowing ASCs to easily provide data-driven insights on cardiac procedures performed in the ambulatory setting.

By incorporating these strategic considerations and adapting to ever-changing payer guidelines and regulatory updates, ASCs can position themselves as leaders in delivering high-quality, cost-effective cardiology care, thereby advancing patient outcomes and enhancing overall healthcare value.

Are you looking for ways to improve your revenue cycle management? Take the first step towards optimizing your revenue cycle process by requesting a revenue assessment from our team of RCM experts. Request a demo.

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