There is a growing movement in the ambulatory surgery center (ASC) industry to include more cardiovascular codes in the Covered Procedures List (CPL).
ASCs have been positioned to transform cardiovascular care in the U.S. since the U.S. Centers for Medicare & Medicaid Services (CMS) added percutaneous coronary interventions (PCIs) to its covered procedure list in 2020.
What’s more, cardiovascular procedures in ASCs are becoming more and more common due to technological advancements, and as cardiologists have demonstrated that many cardiovascular procedures can be safely performed in an outpatient setting.
“I can’t think of a single patient that didn’t thank me for bringing them to the ASC and keeping them out of the hospital,” Dr. David Kenigsberg, a clinical cardiac electrophysiologist and member of the Ambulatory Surgery Center Association (ASCA) Cardiovascular Working Group, said in a recent episode of the ASCA podcast.
“Hospitals could be very dangerous places,” he added.
Still, industry leaders say they need more leeway from CMS to treat patients in the outpatient setting.
In March 2024, ASCA submitted 16 cardiovascular codes to CMS for consideration, including several cardiac electrophysiology procedures. These were not included in CMS’s proposed rule for 2025.
Earlier this month, ASCA again penned a letter to CMS asking the agency to expand the CPL.
“We remain concerned that billing hurdles will impede access to care,” ASCA wrote.
There are significant potential benefits of allowing these procedures in ASCs, particularly from a patient care perspective, Kenigsberg said. He noted that many of his patients, especially Medicare beneficiaries, would benefit from having procedures like pacemaker and defibrillator implants in the ASC setting.
“It’s a very safe environment,” said Kenigsberg, noting that the convenience and safety of ASCs have been proven time and again, with minimal complications reported.
While CMS has yet to approve these cardiovascular procedures for Medicare patients in ASCs, Kenigsberg said that procedures like atrial fibrillation ablations could be safely performed in ASCs.
“I do at least 350 atrial fibrillation ablations a year, and a few hundred other types of ablations a year, in addition to hundreds of cardiac implantable devices,” he said. “I’d love to be able to take some of the healthier and lower-acuity patients out of the hospital setting and safely perform their ablations in the ASC setting, as I think this would result in tremendous cost savings for Medicare and private payers, and be a huge benefit to the patients, improving their satisfaction.”
During the COVID-19 pandemic, when CMS launched the Hospital Without Walls initiative, ablation procedures were allowed in ASCs due to overcrowding at hospitals.
“During that time, thousands of ablations actually occurred in this country under the eye of CMS, that were approved and paid for by CMS,” he said. “And the data and the outcomes were excellent.”
From a clinical perspective, Kenigsberg said he sees no safety rationale behind CMS’s refusal to add certain cardiac ablations to the list. In fact, it may be more dangerous to do procedures in some hospitals.
“There’s a risk of hospital-acquired infection,” he said. “Some of my patients are elderly; they can’t walk very far down long corridors, or they have to be transported. This is very safe, effective, convenient and patient-friendly. At the end of the day, we’re doing this for our patients, so don’t we want our patients to have the best possible outcome in the best possible setting and have great things to say about their patient experience?”
