Spring/Summer 2018


Safely Moving Cardiology Procedures to ASCs By Donald (Buck) Cross, MD


Over the last 10–15 years, advances in technology have changed the way we take care of cardiac patients. A growing number of patients are safely undergoing cardiac procedures in the hospital setting and returning home the same day. This presents an opportunity for cardiologists


to explore whether opening an office-based cath lab (OBL) and/or ASC and moving select procedures to it is a worthwhile investment.


This model has proven such for myself and my partners at Waco Cardiology Associates in Waco, Texas. Approximately seven years ago, we partnered with National Cardiovascular Partners (NCP) and opened a hybrid cardiac OBL/ASC. It has allowed us to be more active in making decisions that affect patient care, while delivering lower-cost care and capturing more of the income generated by our procedures.


At a time when hospitals are increasingly acquiring specialty practices, we remain independent. While there remains pressure on cardiologists, like most physicians, to become hospital employees, we hold up NCP as an example for how to avoid such a scenario and pursue a model that can better serve the interests of physicians and their patients.


If opening an ASC sounds like it may be an appealing venture, make sure to address the following five questions.


1. Who will be your partners? Identify the other physician partners who will bring cases to the ASC and determine how to align the partnership. This can be addressed easily if a single group decides to open an ASC. Matters become more complicated when competitive groups decide to partner to open an ASC.


2. What will your partners bring to the ASC? Determine what each prospective partner will contribute to the new business, i.e., what cases and what level of commitment they will bring. If you have individuals who are interested in becoming business partners but show no commitment to bringing cases, that’s a detriment.


3. What do the laws permit? Understand your state’s rules concerning what procedures you can perform in an ASC. Not all states permit the same procedures. You need to know your state’s laws so you can accurately assess whether you have the volume needed to justify the new facility.


4. What will you be paid? Once you identify the procedures permissible for the ASC, determine their reimbursement. Also gather information on the fixed and variable costs of running the facility. Assemble as much data as possible on the financials so you can run the numbers and determine whether the ASC makes sense from a business standpoint.


5. How will you address the business and administrative components? This is a critical question to answer before proceeding. As a group of physicians, do you believe you have the right experience, knowledge and education to run the business and administrative components of the new business or does it make sense to partner with a company


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that can provide those aspects while you concentrate on practicing medicine? That’s important when addressing matters such as personnel, billing, building inspection and licensure, accreditation, data collection and reporting. For us, partnering with NCP made a lot of sense. They had the expertise to deal with the business and administrative aspects and this allowed us to do what we do best: provide quality cardiac care to our patients. In my opinion, our partnership is the biggest reason for our great success.


Notes on Safety Patient safety must always be at the front of your mind. Here are a few points about the safety of performing outpatient cardiology: • Develop and follow comprehensive guidelines describing those patients you can safely take care of in an ASC and which patients should receive care in a hospital.


• Outpatient cath is still relatively new, so understand that you will be under the spotlight. Err on the side of caution by providing care to people at less risk of complications.


• Complications are possible when performing procedures in any setting. Make sure staff is trained in advanced life support and prepared to care for any patients should they become acutely sick and require stabilization before transfer to a hospital. Establish procedures that allow prompt transfer to your local hospital should the need arise.


• There are numerous published research papers demonstrating the safety of performing cardiac procedures at a site with no surgical backup. In addition, the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions have published position statements stating that this type of work is safe at institutions with no surgical backups. This should instill confidence in pursuing the ASC model.


I have experienced firsthand the numerous benefits of moving cardiology procedures to an ASC. With careful planning and an unwavering focus on safety, I believe many cardiologists are in a position to emulate what we have accomplished at Waco Cardiology Associates. If you choose to pursue this model, good luck in your journey!


Donald (Buck) Cross, MD, is an interventional cardiologist in Waco, Texas, and the national medical director for National Cardiovascular Partners. Write him at buckcross@msn.com.


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


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