Cardiology is one of the fastest-growing specialties for ASCs, and many leaders feel this growth will only accelerate as payers, investors and physicians realize the opportunities.
Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers, a cardiology ASC run by Tri-City Cardiology, told Becker's the migration is "occurring quickly" despite facing payer obstacles.
Private equity recently has taken an interest in the specialty due to a low concentration of private equity in cardiology, the nation's aging population, and changes to Medicare and Medicaid rules.
Additionally, cardiovascular procedures are less expensive in ASCs than in the hospital outpatient department. For example, catheter placement in the coronary artery for coronary angiography — one of the most common procedures — costs $382 at an ASC, versus $919 at an HOPD.
An obstacle in the migration is staffing. While staffing these facilities is attractive for hospital-based catheterization lab teams, because they can offer a five-day workweek without late evenings or weekends, ASC rates are lower making it harder to pay hospital salaries.
"New ASCs developing these specialties need to understand the finite resource level for staff members in their communities compared to regular surgical techs and nurses," Mr. Helmer said. "They need to assess their community's resources to staff these facilities properly."
It also requires a different type of staff than ASCs are used to.
"It requires critically trained techs, nurses and practitioners who are familiar with the risks, technology and treatments involved," he said. "These may not be present in the standard ASC patient. Things like screening patients differently and having well-trained cardiac rad techs and heart techs are key. You can't put a surgery tech in a catheterization lab or a cardiology case and expect them not to feel uncomfortable."
ASC chains are taking note. Optum's ASC arm, Deerfiled, Ill.-based SCA Health, quietly purchased at least two cardiovascular providers in 2023, National Cardiovascular Partners and Pivotal Healthcare. Earlier this year, Marriottsville, Md.-based Bon Secours and Compass Surgical Partners partnered to build a cardiovascular surgery center in Short Pump, Va.
Technology is developing quickly as well, bolstering this migration. Mr. Helmer said that he expects cardiology to "develop efficient technologies that handle a variety of cases safely in the outpatient setting," such as ablations, as well as new technology for procedures like valves, which are currently only allowed for inpatient facilities.
"We've seen technology and surgical instrumentation develop as a result of moving cases to ambulatory surgery centers," he said.
Vendor companies are critical to developing technology that would allow procedures to be performed safely in the ASC setting, he added.
ASC leaders are optimistic about the opportunities for cardiology to further migrate cases to the outpatient setting. Alfonso del Granado, administrator and CEO of Covenant High Plains Surgery Center in Lubbock, Texas, told Becker's that cardiology "represents the single largest driver of new cases and new revenues on the horizon – nothing else comes close to being able to move the needle as quickly as cardiovascular."