In the past two years, CMS has approved 17 cardiac catheterization-related procedures and six cardiology procedures related to percutaneous coronary interventions for Medicare payment in ASCs, according to healthcare valuation and transaction advisory firm VMG Health.
The authorizations contributed to the rise of a hybrid business model that combines an ASC with an office-based lab, which CMS defines as a location where the health professional routinely performs examinations, makes diagnoses and treats illness or injury on an ambulatory basis.
VMG Health weighed the hybrid model's advantages and disadvantages:
Pros
1. The hybrid model can enable existing centers with extra procedure capacity to expand their offerings with cardiology services.
2. OBL/ASC ownership gives cardiologists more autonomy, as well as the potential to increase practice income by recovering facility fees.
3. Moving 5 percent of coronary interventions from hospital outpatient departments to ASCs would save Medicare an estimated $20 million, CMS said in its 2020 final rule.
Cons
1. It is a complex model requiring the OBL and the ASC to be operated as distinct entities with separate tax identification and national provider identification numbers.
2. OBLs and ASCs operate under different CMS coding systems, so hybrid facilities need qualified personnel to ensure claims are properly submitted.
3. Various regulatory hurdles exist at the state level for hybrid models.