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Archive February 2020 XXI, No. 2

Business Advisor: Outpatient Cardiology Is On the Way

Opportunities abound as heart care migrates to same-day settings.

Kelly Bemis

Kelly Bemis


National Cardiovascular Partners
IMAGING IS EVERYTHING Outfitting a cardiac OR will include a radiolucent exam table that allows for a 360-degree view of the patient.

The recent addition of six cardiac interventional procedures to CMS's list of ASC-approved procedures for 2020 creates the opportunity for ambulatory surgical centers to add an emerging new service line. Cardiac catheterizations and stent placements might soon be regular and routine occurrences in outpatient settings. Here's what you need to consider if you want to get involved in a growing and potentially profitable service line.

  • Skilled staffing. First and foremost, you'll need to find committed cardiologists who are willing to do their cases in the ASC environment. You'll also need to recruit highly skilled and experienced cardiovascular RNs and radiologic technologists. These are specialized positions that require years of training. It's not safe to assume that traditional OR staff members can adapt quickly to cardiology, so forming a separate team of experienced professionals is a must.
  • Start-up capital. The main piece of equipment you'll need is a fixed C-arm designed specifically for cardiac procedures that mounts to the floor or the ceiling. The operating table for cardiac procedures has a radiolucent surface and is designed to allow for 360-degree views of the coronary vessels when the C-arm rotates around the patient. You'll also want to consider purchasing an ultrasound machine, micro-puncture needles and an assortment of sheaths, guidewires and stents. In total, these items could cost upward of $1 million. Pacemakers and defibrillators typically are delivered to facilities on consignment by the manufacturers, so there are no upfront costs to maintain an inventory of those devices.
  • Big footprint. An interventional cardiovascular suite consists of a procedure room, an equipment room and a control room. The procedural space must be larger than a traditional OR — large enough to comfortably house the C-arm, the radiolucent table and ancillary equipment. Although square footage varies from facility to facility, you basically need the space of two standard operating rooms to make one fixed interventional suite.
  • Emergency equipment. While emergent events are rare, they do occur and you must be prepared to manage them. Be sure to have a dedicated crash cart that will be kept in the cardiovascular interventional suite. You should also have available an intra-aortic balloon pump (IABP), pericardiocentesis kit, temporary pacemaker and, if possible, covered coronary stents.
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