“They realized it was becoming more difficult to secure the time at the hospital to perform non-acute procedures because they were competing against every sur- gery and specialty,” Cassy Kincaid, the ASC’s director, says. “They thought that if they opened an ASC, they could at least use it to take care of patients who needed pacemakers, defibrillators and generator—i.e., battery—changes. That is how our ASC was born.”

Cardiology Moves into the ASC Setting The time is ripe for surgery centers to do more heart procedures BY ROBERT KURTZ


till a relatively new specialty for ASCs, cardiology is quickly cement- ing itself as one of the most promising. “Cardiologists who embrace the ASC model are finding that they can safely shift a good amount of their diagnostic cases and some interventional cases out of the hospital,” says Kelly Bemis, RN, chief clinical officer for National Car- diovascular Partners headquartered in Edina, Minnesota. “We have an abun- dance of data that show these patients do well in an outpatient setting and experi- ence very positive outcomes.” The Heart & Rhythm Institute of

Trinity in Trinity, Florida, performed its first cardiology case in 2016 and now delivers a wide range of cardiac proce- dures five days a week. “Bringing cardi- ology into ASCs is a great way to deliver safe care more efficiently and at a huge cost savings,” says the ASC’s administra- tor Sheree Leppinen, RN. “Our patients love the experience, especially the safe, comfortable environment and continu-


Kelly Bemis, RN, will present “Cardiology: The Emerging Outpatient Specialty” from 9:10– 10:10 am on May 14. Review the complete schedule on the ASCA 2020 Conference & Expo website. annualconference/schedule

ity of care. They tell us how much they appreciate having the same caregivers from reception through discharge.” In

late 2013, when cardiolo-

gists practicing at the Alaska Heart and Vascular Institute in Anchorage, Alaska, began looking for an alterna- tive to the hospital for their patients, they decided to open the Alaska Car- diovascular Surgery Center.


Promising Path Cardiology in ASCs is ripe for growth, says Leppinen, who points to recent Centers for Medicare & Medicaid Ser- vices (CMS) rules as reasons for her optimism. The 2019 final payment rule added diagnostic catheterization proce- dures to the list of ASC-covered surgi- cal procedures, while the 2020 payment rule addresses interventional procedures. “We are already performing these procedures with managed care patients, and our cardiologists are ready to deliver that same great care to Medicare patients,” Leppinen says. “As the Medi- care population continues to increase, hospitals will need to focus on the more acute care patients, allowing surgery centers to perform elective procedures on healthier patients who do not require a hospitalization.”

The migration of elective cardiac procedures from the inpatient to the outpatient setting has been underway for years, Bemis says. Approval of the proposed interventional procedures will accelerate that shift. “Not only could we perform the diagnostic por- tion of the procedure on a Medicare patient, but if this individual required treatment, such as needing a balloon angioplasty or stent placed, we could deliver it at the same time,” she says. Kincaid says her ASC looks into

expansion opportunities frequently and, looking to be as innovative as possible without putting patients at risk, sees a tremendous need for the cardiology ser- vices it can provide. “For example,” she says, “we are providing an increasing number of implantable loop recorders.” During those procedures, a recorder is placed into the cardiac space and

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