Cardiology has emerged as a leading specialty in the ASC industry, particularly as increasingly complex procedures migrate to the outpatient setting.
According to Avanza’s "2022 Key ASC Benchmarks and Industry Figures" report, cardiology is the fastest-growing ASC specialty, drawing attention from both private equity and other consolidators in the ASC space.
Optum's ASC arm, Deerfield, Ill.-based SCA Health, acquired at least two cardiovascular providers in 2023, for example, National Cardiovascular Partners and Pivotal Healthcare. National Cardiovascular comprises 21 cardiac catheterization and vascular labs. Ponte Vedra Beach, Fla.-based Pivotal Healthcare operates 11 affiliate practices and 14 locations. Earlier this year, Marriottsville, Md.-based Bon Secours and Compass Surgical Partners partnered to build a cardiovascular surgery center in Short Pump, Va.
But Richmond, Va.-based Virginia Cardiovascular Specialists has managed to maintain its independence despite hefty competition in the area, soaring operation costs and other factors threatening ASC independence.
"There aren't very many of us. We should start with that," John Onufer, MD, a cardiologist and medical director of VCS told Becker's. He said that while the ASC opened in January 2023, a number of insurance and other administrative requirements had to be met before the practice was fully in operation — which is why a solid managerial team is key to success in the ASC cardiology space.
"They're going to do all the heavy lifting in terms of fulfilling all the regulations. And there are a lot of regulations, but they're there for good reasons," Dr. Onufer said, "But they do require a real, detailed administrative staff."
This is particularly important in cardiology, as the migration of complex procedures to the outpatient setting has outpaced updates to regulation and certificate-of-need requirements in some states.
VCS also recently added an outpatient cardiac catheterization lab to the ASC, the first facility of its kind in the state.
"And already we're realizing just in terms of how we're going to try to run both those services at the same time — of both types of procedures at the same time — that we're already outgrowing our space," Dr. Onufer said. "We expect that more procedures will become supported by the payers to be done in outpatient settings."
The leadership structure at VCS is key to supporting this rapid growth without interference by competitors.
"The initial [founding] members of the group made it pretty clear early on that the success of the group would be greatest if all shareholders have equal status," Darryn Appleton, MD, the director of VCS' cardiac catheterization lab, told Becker's. "So there's no seniority kind of situation where senior members have more say. Whenever we're coming up with new ideas to launch a venture like this, it's all based on equal votes."
This structure lends itself to a more collaborative and engaged style of practice management, he added.
"It's a lot of work to be all on the same page about these different things. Of course, there's going to be different opinions," Dr. Appleton said. "The active process of governing in a big, independent group like that, that's trying to do big things, means we really have to meet frequently and pay close attention to what's happening across the practice."
Dr. Onufer also added that, with the rapid pace of developing technologies in cardiology and in healthcare overall, ASCs will continue to take centerstage as an efficient and economically preferable setting for outpatient procedures.
"This is the wave of the future," said Dr. Onufer. "Even some academic centers are opening up ASCs. You have to realize that we need to use the technology we have to provide our services more economically, and at the same time, more efficiently, for the providers. I certainly can do a lot more cases in the ASC in one day than I can in the hospital."