4 considerations for adding cardiology procedures to your outpatient facility

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Increasingly, cardiovascular procedures are moving into the outpatient setting, spurred by technological advancements, regulatory changes, potential cost savings and patient preference. But outpatient settings, such as ASCs, hospital outpatient departments and office-based laboratories looking to add these procedures to their offerings must take note of certain financial, operational and regulatory considerations.

During the Becker's Cardiology Virtual Forum, I. Naya Kehayes, principal, and Sean Hartzell, associate principal at ECG Management Consultants discussed the trend of cardiovascular procedure migration to the outpatient arena and noted important considerations for facilities looking to grow their outpatient cardiovascular service line.

Here are four key considerations:

1. The migration of cardiovascular services to the outpatient setting is driven by several stakeholders, including employers, hospitals, payers, physicians and patients, Mr. Hartzell said. Patients, in particular, prefer the outpatient setting as it is relatively free from the risk of COVID-19, as compared to hospitals. Other stakeholders are looking to improve operational efficiency and throughput while gleaning potential cost savings.

"We've spoken with many physicians, and many administrators recently, who have seen a large increase in their patients' desire to migrate to a COVID-free environment, which really revolves around ASCs and office-based labs," he said.

2. In 2019, CMS changed the definition of "surgery," which resulted in cardiac catherization and coronary interventional procedures being added to the approved ASC list, opening up a host of new offerings for outpatient settings to implement, Ms. Kehayes said. In 2020, CMS added more cardiology procedure codes to the list allowing facilities to expand these offerings even further. But it is important that ASCs and office-based labs keep track of both federal and well as state regulations governing outpatient cardiology, and if state regulations prohibit certain cardiology procedures from being performed on an outpatient basis, it supersedes the CMS approvals, she said.

Also, outpatient facilities must take note of payer policies. Payment rules for outpatient cardiology procedures may differ between CMS and commercial payers, and among the private payers as well.

3. Operationally, outpatient facilities need to ensure they have the appropriate clinical protocols, patient selection criteria and credentialing processes in place, Ms. Kehayes said. Engaging with your physicians will be key in determining these protocols and processes as well as in deciding the equipment and staff that may need to be added to your facility.

4. Outpatient facilities implementing cardiology procedures also need to make sure they will get reimbursed adequately. Facilities should engage in contract negotiations with all payers before adding any new procedures, Ms. Kehayes said. Before entering the negotiations, outpatient facilities should evaluate case costs associated with the new cardiology services and collect data on implants and capital required for equipment needed for the procedures.

"If you want to encourage migration, ensure the commercial rates are high enough to offset any losses expected from Medicare and other government payers which are non-negotiable, but [also] show the payers what that volume opportunity is," she said. "Prepare data that demonstrates your value, shows the potential for migration and shows that the ASC represents the savings."

View the session here.

 

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