As cardiology increasingly shifts toward outpatient care, procedures once reserved for hospital catheterization labs are carving out space in ASCs.
Vance Chunn, CEO of Mobile, Ala.-based Cardiology Associates, joined Becker’s to discuss the diagnostic and interventional cardiology procedures that are already migrating and the complexities preventing others from making the leap.
Editor’s note: This response was edited lightly for clarity and length.
Question: What specific cardiology procedures you’re seeing move to the ASC setting?
Vance Chunn: Some aren’t approved yet, but the ones that are, and that will likely become the bread and butter of ASCs, include diagnostic caths and low-risk interventions. You’ve got to be careful with interventions — complex ones aren’t a fit without hospital backup. But diagnostic caths, percutaneous coronary interventions, and some low-risk EP procedures like pacemakers and ICDs, are being done. Transesophageal echocardiography is another. That’s pretty straightforward to do in an ASC.
Peripheral vascular interventions are a bit of a hybrid. People have done those in office-based labs without needing a certificate of need. That includes things like leg or carotid blockages. The reimbursement for some reason, maybe due to the vascular surgery lobby, is actually better in a physician office than an ASC. Some centers do this hybrid model where one day they’re an office-based lab and the next they’re an ASC. But you have to have separate employment records, different billing structures — it gets complex.
So peripheral stuff can be done in ASCs, but many are still doing it in offices because of reimbursement. Vein procedures too — like varicose vein repairs, vein ablations — those are common in ASCs.The procedures that aren’t moving yet, but might in the future are more complex arrhythmia treatments, like ablations. And some complex coronary interventions may never move out of hospitals, but we’ll see.
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