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OUTMIGRATION OF CARDIOLOGY – LOGISTICAL CHALLENGES FOR ASCS + HOW HOSPITALS ARE BRACING FOR VOLUME LOSS

CMS' 2019 Outpatient Prospective Payment System rule cleared the way for some cardiac procedures to be performed in ASCs, creating financial uncertainty for hospitals, according to Ronald Hirsch, MD, vice president of regulations and education group for R1 RCM.

Dr. Hirsch shared his thoughts on the topic with Becker's ASC Review. 

Note: Responses were lightly edited for style and clarity. 

Question: CMS' 2019 payment updates could accelerate the migration of cardiology cases to ASCs. How soon do you think that shift will take place?

Dr. Ronald Hirsch: I don't think the migration could come soon enough for the ASCs, but the logistics can be daunting. Many ASCs are running at near capacity, so finding the space and the funding to add a completely new service line with its own specialized equipment will be a challenge. Then, recruiting and credentialing physicians will take time and effort. And, of course, adding new partners to the ASC's corporation is certain to require time and effort from their financial and legal colleagues.

Q: What decisions should we anticipate from CMS and commercial payers in the one to two years ahead?

RH: As surgical techniques continue to improve, especially in the management of post-surgical pain, and our ability to provide more specialized care in the home improves with advances such as telehealth and remote monitoring, I foresee a continuing shift of elective surgical care away from hospitals. CMS has also made clear with its just-announced Radiation Oncology Model, a mandatory demonstration project that will pay hospital-based and freestanding radiation centers a fixed amount per episode of care, that it intends to push forward with its shift to a site-neutral payment structure. One large national insurer has already adopted site-of-service rules that limit the provision of intravenous chemotherapy and the performance of elective arthroscopy to the non-hospital setting unless there are extenuating circumstances.

Q: How are hospitals preparing for these changes and the outmigration of cardiology?

RH: We are already seeing hospitals partner with physicians in building new ASCs and converting existing hospital-based space to be designated as an ASC. These efforts will take a significant amount of financial finesse as the physicians could also choose to go at it on their own or perhaps with the help of venture capital, which is flowing into healthcare in increasing amounts, leaving hospitals on the outside looking in. The advantage hospitals have is that they have the expertise to operationalize a cardiac program, whereas physicians have the technical abilities to perform the procedures. Being able to stay out of the weeds of running the program while at the same time benefiting by both providing quality care to their patients in a convenient setting and sharing in the profits should be appealing to cardiologists. Hospitals will continue to need cardiologists to care for hospitalized patients who require acute and emergent cardiac care, and cardiologists will continue to need a hospital for those patients who are too sick for an ASC, so it is in both of their interests to work together in a collaborative manner.