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FEATURE


stays there for as long as three years. The device feeds information back to physicians, allowing them to monitor performance of a patient’s heart and catch possible problems early. “It is incredible technology,” she says. “As we achieve advances in micro instrumentation and minimally invasive procedures, more procedures will come into the outpatient environment,” Bemis notes. “We are on the right trajectory.”


Noteworthy Challenges While the future of cardiology in ASCs is bright, there are certain challenges hindering growth, Bemis says. “There are still many cardiologists employed by hospitals. When you are employed, the hospital typically wants you to do your work in their facilities. If a hospi- tal lacks an affiliated ASC, performing procedures at a surgery center proba- bly will not be an option.”


Kincaid says she has found that it is just as difficult to recruit a cardio- vascular physician as it is to add a car- diovascular-trained nurse. “Staffing is a very competitive area. In addition to competing with hospitals, we are also up against temporary staffing agen- cies with entire cath lab divisions,” she says. “We have set a very high bar on the clinical experience we require for such staff. We make sure that the peo- ple we employ know how to properly manage and respond to the most criti- cal situations they may encounter in our ASC.”


Finding and retaining that staff is essential, Leppinen says. “Consider- ing the type of procedures we are per- forming, there is always a concern for complications. You need experienced cath lab staff who can take care of such emergencies without hesitation.” Existing ASCs interested in add- ing cardiology might encounter more difficulties than they have found when adding other specialties, Bemis says. “Cardiology rooms are bigger. If you are an existing ASC and have inter- ested cardiologists, can you give up two of your operating rooms to build one fixed interventional suite?”


The growth of cardiology in ASCs will greatly benefit patients and bring significant savings to the economy.”


—Sheree Leppinen, RN, Heart & Rhythm Institute of Trinity Cardiology patients tend to stay


at the ASC longer than most other patients, Bemis says. That means a recovery bed is occupied for a longer period. “Do you have that space avail- able?” she asks. “These are just two of the many questions you will need to answer to determine whether your ASC is ready for cardiology.” Some states, such as California and Ohio, are not on board yet with ASCs performing cardiac procedures on Medicare patients, Bemis says. “Even though CMS has approved these pro- cedures, several state legislatures do not permit them. For ASCs in these states, that is a significant barrier to bringing in the specialty.”


Adding the Specialty Leppinen advises ASCs thinking about adding cardiology or


cardiologists


thinking about starting their own ASC to ‘go for it.’


“It is a great field that is only getting


stronger,” Leppinen says. “We call our center the ‘Heart of Trinity’ because we make such a positive impact on our patients’ lives. The growth of car- diology in ASCs will greatly benefit patients and bring significant savings to the economy.”


Build support for cardiology in the ASC setting before proceeding with


development plans, Kincaid advises. “Start with securing backing at the political and community levels before you fully dive in. Hospitals do not want to see the loss of their cardiology busi- ness, so you can anticipate some push- back. Without support at those levels, you will likely struggle.”


Also determine whether your health plans will provide coverage for cardiology procedures performed in the ASC, Kincaid says. “The good news is that it seems more are coming on board with the idea.”


After being an operating room nurse for 20 years, Bemis says, cardi- ology is like no other ASC specialty. Any ASC interested in adding cardiol- ogy must consider many factors care- fully, for example, what does build- ing an interventional suite entail, how does payer contracting work, what emergency equipment and training is required and how can an ASC work effectively with a health system for potential patient transfers. “Cardiology is its own ballgame,”


she says. “It is a great specialty for ASCs. Find someone who is knowl- edgeable and understands the space to be your partner. You are going to want that support.”


ASC FOCUS JANUARY 2020 | ascfocus.org 21


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