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Archive February 2021 XXII, No. 2

Cardiovascular Care Is the Next Big Thing

Procedures are shifting to surgery centers, but adding the cases is not for the faint of heart.

Joe Paone

Joe Paone

BIO

MESSAGE STENT
MESSAGE STENT In 2020, CMS began reimbursing ASCs for minimally invasive cardiac procedures such as stent placements.

Cardiac surgery is the next frontier for same-day surgery. The movement of cardiovascular care from hospitals to freestanding surgery centers is being driven by reimbursement trends, forward-thinking facilities and the steady beat of progress. "Cardiology is another step in providing more surgical care on an outpatient basis for more patients, while saving the healthcare system a significant amount of money," says Bill Prentice, CEO of the Ambulatory Surgery Center Association. The fledging service line is packed with promise — and plenty of questions that need to be answered.

What's the payment landscape?

Before 2019, the only procedures for which ASCs could be reimbursed by CMS were implantations of defibrillators and pacemakers — what cardiology pros call "device work." The 17 cardiac-specific ASC codes CMS added for 2019 focused exclusively on diagnostic cardiac catheterization procedures that physicians were already performing in HOPDs. These allowed ASCs to diagnose cardiac issues, but not yet perform "surgery-like" minimally invasive interventions. Six more cardiac ASC codes came online in 2020, this time adding minimally invasive procedures referred to as percutaneous coronary interventions (PCI), specifically placing stents and angioplasty. This year, 11 additional, more complex PCI procedures were added, including lower extremity intravascular lithotripsy and atherectomy.

Mr. Prentice says CMS reimbursement for ASC-approved cardiac procedures needs to increase to drive adoption. "When CMS made the initial move to add cardiac procedures to our reimbursement list, they estimated if just 5% of coronary interventions moved from HOPDs to ASCs, it would save the Medicare program $20 million a year," he says. "If they don't set the reimbursement rate for these procedures correctly, you're not going to see that migration. I think [adoption] is going to be slow and steady. We need reimbursement policies that incentivize ASCs to want to take on this service line."

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