Similar to the orthopedic boom a decade ago, cardiology has emerged as the next major growth opportunity for ASC growth as these high-acuity cardiac surgeries migrate to the outpatient setting.
"Cardiology is now the big hot ticket for ASCs," Bruce Feldman, administrator of Eastern Orange Ambulatory Surgery Center in Cornwall, N.Y., told Becker's. "A lot of centers are beginning to do cardiac procedures, vascular stenting, ICD implants, etc."
According to Avanza’s “2022 Key ASC Benchmarks and Industry Figures” report, cardiology is the fastest-growing ASC specialty.
Major ASC chains are taking note. Optum's ASC arm, Deerfield, Ill.-based SCA Health, acquired at least two cardiovascular providers in 2023. National Cardiovascular Partners comprises 21 cardiac catheterization and vascular labs. Ponte Vedra Beach, Fla.-based Pivotal Healthcare has 11 affiliate practices and 14 locations. Earlier this year, Marriottsville, Md.-based Bon Secours and Compass Surgical Partners partnered to build a cardiovascular surgery center in Short Pump, Va.
Despite this trend, Mr. Feldman said that New York has not yet approved many cardiology codes for ASCs, while 26 other states have moved forward. While he expects outpatient cardiology to become more widely accepted soon, hospital lobbies are a big obstacle in the migration.
"[Hospitals] don't want to lose these cases to the ASCs. These are lucrative cases for the hospital, and they've spent millions of dollars building catheterization labs," he said. "If all that volume goes to the ASCs, how could they backfill those labs?"
This is why much of cardiology ASC development is in places like the Midwest or California, he said, where there's less consolidation by larger health systems.
"Major cities have large healthcare systems who have huge lobbying power in Washington to fight the migration of these procedures," he said. "They did the same thing five years ago with joint replacements, but now 95% of joint replacements are done in an ASC rather than a hospital."
Additionally, 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.
Looking ahead, Mr. Feldman expects cardiology to enter the ASC through single-specialty centers. Catheterization labs are very expensive to build and so it's often cost-prohibitive for multispecialty ASCs to add cardiology.