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Bringing Cardiac Cases into ASCs Come to ASCA 2018 to learn how to run a successful heart-centered surgery center BY SHEREE LEPPINEN


Interest in performing car- diac procedures in the out- patient setting is growing, and the Heart and Rhythm Institute of Trinity is at the


forefront of the movement. Although the Centers for Medicare and Medic- aid Services (CMS) does not yet reim- burse ASCs for these procedures, many managed care companies do. With an increasing number of outpatient centers providing cardiac procedures, growing awareness of the cost savings and the positive experiences that patients report, the chances of cardiac procedures being performed in ASCs is rising. During my presentation at ASCA


2018, April 11–14, in Boston, Mas- sachusetts, I will discuss the initial startup of our ASC for cardiovascular patients, the hurdles and the rewards. I will present the process of the patient experience in the clinical setting and discuss the business development, bill- ing, coding and reimbursement pro- cesses in a cardiac ASC setting. The Heart and Rhythm Institute


of Trinity has been in operation since June 2016. Our surgery center houses the first hybrid lab in Florida with an outpatient catheterization laboratory, or cath lab, and an ASC. We wanted to start an outpatient


facility to perform cardiovascular pro- cedures that would benefit the commu- nity by providing safe, effective care at a considerably lower cost than the hospitals. We had been researching this concept for many years, and due to hospital acquired infections, patient dissatisfaction, the extended lengths of stay, and the rising cost of health care, we decided to move forward and make a difference in our community. Originally, we were going to have an office-based, outpatient cardiac cath lab. When we realized that by adding the


ASC component, we would be allowed to provide more cardiac procedures based on Medicare reimbursement, we decided to open the ASC as well. The setup of an ASC is more com- plicated than a cath lab, and it must be built to specific architectural and engi- neering standards to be granted licen- sure from the state and accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC). We thought it would take about a year, but it took 27 months to open our doors. Today our surgery center provides services like pacemaker, implantable cardiac defibrillator (ICD), and biven- tricular (BIV) ICD implants, electro- physiology (EP) procedures and cor- onary stent/angioplasty, in addition to peripheral vascular procedures. The managed care companies we work with see huge savings when these pro- cedures are performed in an ASC set- ting instead of the hospital setting.


10 ASC FOCUS JANUARY 2018 |www.ascfocus.org


Our patient satisfaction indicator is


excellent. The patients have their pro- cedure and go home within the next four to six hours depending on the type of procedure. They are impressed with the cleanliness of our facility, the efficiency and experience level of our staff and the exceptional attention they receive. They enjoy the smaller envi- ronment—compared to a hospital— and the personal attention they receive. We are looking forward to a time


when many more of these procedures will move into the ASC setting. I will share more about the procedures we are already performing and those we expect to be able to perform in the future when we meet at ASCA 2018.


Sheree Leppinen is the director of nursing and administrator at Heart & Rhythm Institute of Trinity/Cardiovascular Institute of Trinity in Trinity, Florida. Write her at S.Leppinen@cardiovasculartrinity.com.


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