Now that CMS has approved reimbursement for percutaneous coronary interventions (PCIs), among other cardiovascular procedures, in the ambulatory surgery center (ASC) setting, Medicare-accredited surgery centers around the country are deciding what part PCI should play in their organization.
At the same time, the possibility of offering outpatient PCI opens up a myriad of issues, ranging from supply questions to the impact of a pandemic. For ASC leaders considering offering PCI to their care communities, there are five, key points of awareness to keep in mind.
- It’s beneficial to a range of stakeholders.
Countless patients around the country have already had PCI procedures performed at ASCs. This is because they offer a range of benefits to multiple stakeholders. One of the most clear cut benefits is cost savings to Medicare. At an average ambulatory reimbursement2 rate of around $6,000 or less, compared to $12,000 in the hospital environment, outpatient PCI is expected to save Medicare around $20 million per year, and beneficiaries another $5 million in out-of-pocket expenses. In terms of patient safety, PCI3 has been performed safely in the hospital outpatient setting for the last decade.
Clinical trials have shown no significant difference in major short- or long-term adverse cardiac events when PCI is conducted in the ASC versus a hospital setting. This is largely thanks to appropriate patient and access site selection, reduced equipment size, bleeding avoidance strategies, and advances in technology. Patients additionally enjoy easier parking, admission, and discharge in the ASC setting.
On the clinician side, outpatient PCI returns control to physician hands since so many ASCs are physician-owned. - There are enough cardiologists.
The viability of an ambulatory cardiology center or program will depend heavily on the availability of independent cardiologists, but this is not an impossible hurdle to cross. Orthopedics, for example, saw similar challenges when orthopedic procedures began migrating out of the acute setting. In response, independent orthopedic surgeons simply began consolidating to form independent centers. Expect to see single specialty ASCs evolve most rapidly in markets where there are enough independent cardiologists to support patient volumes and keep a facility busy, avoiding downtime and preventing financial challenges. This is most likely in markets where there are around five independent cardiologists who can partner together in an ASC joint venture. - PCI in the ASC setting aligns neatly with current healthcare trends.
It's not a coincidence that more procedures, PCI included, have steadily been moving into the ambulatory setting.The consumerization of healthcare has encouraged patients to seek care outside hospitals while provider-led “Hospitals Without Walls" initiatives have expanded the way many healthcare consumers shape their expecta-tions of care accessibility. Ultimately, offering PCI in the ASC setting supports an expanded commitment from providers to “do no harm" by offering safety and quality outcomes while minimizing financial burden and isk to the patient, insurance company, and the taxpayer. - You will face new procurement challenges.
Offering PCI in the ambulatory setting presents new challenges for ASC materials managers. They will be tasked with qualifying and creating optimal partnerships in distribution, medical and surgical supplies, pharma, interventional procedures, freight management, and analytics to insure the profitability of the PCI program, along with the safety and results of cardiac patients. While many of these challenges may be new, procurement decisions should be based on the well-being of the patient and the practice to maintain outcome quality and support financial health.
For more insights into the ASC space, visit https://www.cardinalhealth.com/en/services/acute/surgery-centers.html.