The continued migration of cardiac procedures to the outpatient setting has spurred development of cardiac and vascular ASCs.
Becker's reported on 26 cardiology-focused ASCs opened or announced in 2024. And, according to ASC strategic services provider Avanza's "2022 Key ASC Benchmarks and Industry Figures" report, cardiology is the fastest-growing ASC specialty.
However, the continued expansion of cardiology faces challenges in states with certificate-of-need laws. While CON laws regulate the development and approval of all healthcare facilities, the rapid development of technology for cardiac procedures has outpaced updates to regulation in some states.
This was the case for Richmond-based Virginia Cardiovascular Specialists. The group recently opened the state's first freestanding, Medicare-approved outpatient cardiac catheterization lab within VCS' Heart and Vascular Center, an ASC. The group received CON approval in January 2024.
"One of the biggest challenges that we experienced when we were doing the CON was the fact that the state manual for the CON for a cath lab was written, in the '80s or '90s, many years ago, when outpatient cath labs were just not a thing," said Danielle Martin, an administrator and director of physician services at VCS.
While this at first posed a challenge to VCS' application, the Virginia Department of Health ultimately recognized the discrepancy between written law and the current healthcare landscape in the state.
"[The law] didn't really address the needs of having an outpatient cath lab and all the wonderful things that go into an ambulatory surgery center offering a quality place for people to come and have their procedures," Ms. Martin said. "The state did recognize that there was a need for our area to have that option out there for our population. But that was definitely a big hurdle that we had to overcome."
CON laws vary state-to-state, but the team at VCS found success in highlighting to the state board that, by creating an outpatient setting for less acute cardiac procedures to take place, the ASC could prevent in-hospital cardiac catheterization labs from becoming overcrowded. This is particularly relevant for cardiac catheterization, Darren Appleton, MD, director of VCS' cardiac catheterization lab, explained to Becker's as hospital labs tend to have a more "difficult mix" of inpatient and outpatient procedures.
"One of the things that will serve the public well is if this type of thing expands to cases that are less acute. Everything very much lends itself to be a very scheduled type of routine," he said.