As investors continue to back ASC bread-and-butter specialties such as gastroenterology and orthopedics, it is worth examining if cardiology has the same growth potential in the surgery center space.
Prashanth Bala, vice president of ASC operations at Shields Health in Quincy, Mass., spoke with Becker's to discuss if cardiology can one day catch up in popularity to gastroenterology and orthopedics.
Editor's note: Responses have been lightly edited for length and clarity.
Question: Do you see cardiology becoming as popular as gastroenterology or orthopedics in the ASC space in the near future?
Prashanth Bala: I think the challenge with cardiology being as prominent will be determined by the health of the patient. As a result, I don't know if it's going to be as prominent as GI or orthopedics for three reasons.
Number one is the health of the patient. Is it appropriate for that patient to be outpatient? One of the selection criterias that many surgery centers have is on the cardiovascular health of the patient. If that's what they're coming in to have surgery for, it's typically harder to have that patient be appropriate for surgery in the outpatient setting.
Number two, I think it goes back to what we talked about with regards to barriers of entry into the game. One, are all the CPT codes reimbursable on the Medicare Fee Schedule or on commercial contracts? Therefore, is it allowable for it to be done in the outpatient or ASC setting?
Three, do the states permit it? As a result of many regulations, in terms of what procedures can or can't be performed at an ASC, you have to look at the state regulations, which might limit [ASCs'] ability to do certain procedures, therefore, limiting the overall appetite for a group of providers to be able to operate independently from their hospital.
You can also probably go down the line and say there's other barriers to entry such as the cost of equipment. Cardiology requires a lot of different equipment. It requires costly implants. Especially if those implants aren't reimbursed or if the capitated rate for that procedure isn't reimbursing the implant, you may not be able to do those procedures in the outpatient setting. There are a number of different factors that make cardiology different from GI or orthopedics. I did hear a cardiologist once tell me that when it comes to surgery centers, GI and orthopedics are sort of in the ninth inning and cardiology is still in the first inning of the game. So it's going to be some time before cardiology can catch up to what we see GI and orthopedics doing.