Cardiovascular procedures are emerging in the outpatient setting after a push from CMS.
Here are five insights from The National Law Review on how cardiovascular procedures migrated to the outpatient setting:
1. Cardiovascular services are less expensive in the outpatient setting and provide "greater comfort and convenience" for patients.
2. CMS encouraged the migration by adding 17 cardiac catheterization procedures to the ASC-payables list in 2018, and then authorized the provision of percutaneous coronary interventions by adding six CPT codes to the payables list in 2019.
3. ASCs are adding cardiovascular programs through either co-management arrangements or by implementing hybrid models. In co-management models, ASCs contract with a cardiovascular medical group to run a cardiovascular program within the ASC. In the hybrid model, the ASC builds a freestanding office-based laboratory, catheterization laboratory or vascular access center within the ASC.
4. Despite having approval from CMS, ASCs must work within state restrictions around developing cardiovascular programs. About 33 percent of states do not permit the hybrid model, and some states do not allow ASCs to perform all the CMS-approved procedures.
5. Most states, too, have a certificate-of-need requirement around establishing new service lines.
Despite the hurdles, The National Law Review said, "We imagine the trend towards the provision of outpatient surgical services in the ASC setting to continue as CMS continues to increase the number of ASC cardiovascular procedures reimbursable under Medicare and states weaken their unfavorable restrictions."