ASCs have a massive opportunity to improve their cash flow, growth rate and net worth by integrating cardiology procedures, according to three experts from National Medical Billing Services.
During Becker's ASC Virtual Event on Sept. 30, Nader Samii, CEO, Kylie Kaczor, senior vice president of clinical and regulatory affairs, and Scott Allen, vice president of managed care contracting, spoke about the strategic benefits of bringing cardiology to ASCs. National Medical Billing Services sponsored the session.
Four key takeaways:
1. Cardiology is booming. One-third of cardiology procedures are expected to be done in the surgery center environment by 2021, compared to just 4 percent in 2016. That 230 percent increase over six years makes cardiology the fastest growing specialty right now in the surgery center market.
It's also a revenue-driving specialty. From 2015-21, the amount of revenue generated by the ASC market is expected to grow at an even steeper rate than procedure volumes due to increasing case complexity in these facilities.
2. COVID-19 lets ASCs shine. Announced March 30, CMS' "Hospitals Without Walls" program gives ASCs the chance to temporarily enroll as a hospital during the public health emergency, as long as they meet certain requirements.
"That allowed ablations — which are reimbursed around $20,000 from a Medicare standpoint — to be performed in an ASC," said Mr. Samii. "So, with the track record that will be able to be shown, relative to outcomes, that could be another procedure that could move over [to ASCs more permanently]."
3. Current limitations aren't set in stone. This year, California lawmakers pushed for allowing certified ASCs to provide elective cardiac catheterization lab services. Although the bill didn't pass, according to Ms. Kaczor, it's a sign of possible changes to come — as is CMS' proposal to add 270 surgery-like codes to the ASC-payable list in 2021.
"There's definitely something to watch there," Ms. Kaczor said. "Advocacy efforts continue to bring more and more of the cardiology specialty into the ASC."
4. Clinical advances make the hybrid model feasible. Key additions to the ASC-payable list have increased the popularity of hybrid ASCs/office-based labs, which are singular facilities that operate as ASCs on certain days and office space on the others. This model, and the provision of outpatient cardiovascular care in general, is full of complexities.
"Cardio is a tricky specialty because not only do you have cases that require high implant costs, you have codes that may not be approved by Medicare," said Mr. Allen. So, to bring in these cases, "you'll definitely need a full understanding of that managed care contract, and everybody along the revenue cycle will need the same understanding."
Click here to view a recording of the session.