OR Manager April 2022 - 28
Key items for cardiovascular, peripheral vascular service lines
AMBULATORY
A
mbulatory
surgery
centers
(ASCs) are ramping up cardiovascular
and peripheral vascular
service lines, as Medicare offers payment
for a growing number of cardiac
procedures and accrediting bodies offer
support for this methodology. In 2021,
the Medicare Payment Advisory Commission
reported that the number of
ASCs billing Medicare for cardiology procedures
jumped from 12 in 2014 to 88
in 2019.
Deb Yoder, MHA,
BSN, RN, CNOR, recalls
her reaction when ASCs
began doing cardiac
procedures. " My first
thought was, I can't believe
we're even thinking
of doing this in the ASC
environment. " Surgical
and interventional techchecklist
involving state regulations; the
right equipment, including appropriate
emergency and backup needs; as well
as choosing the right patient populations,
she says.
Q: How safe is it to do cardiac
procedures in an ASC?
Deb Yoder,
MHA, BSN,
RN, CNOR
nology, procedural technique, equipment,
and medication have since evolved over
the last 30 years. However, providers
must also be aware of each patient condition
and understand the concept that
" just because we can does not always
mean we should, " she added.
ASCs can do cardiovascular procedures
at much lower rates than hospital
outpatient departments. The Centers
for Medicare and Medicaid Services
estimates that moving 5% of coronary
interventions from hospital outpatient
departments (HOPDs) to ASCs could reduce
Medicare payments by about $20
million, Yoder reported during the OR
Manager Conference in October 2021.
Her prediction: Based on current reports
from Medicare and whitepapers,
ASCs will be completing 50% of all
cardiovascular procedures by mid to
late 2020s. In this interview with OR
Manager, Yoder, vice president of clinical
operations at Surgical Management
Professionals in Sioux Falls, South Dakota,
discusses what ASCs should do
to ensure safety in the OR during a
cardiac procedure. It is a multi-factorial
28
OR Manager | April 2022
Any time you touch a patient or put a
patient to sleep, it can be risky. Any
intervention related to the coronary vessels
is risky. The provider is working in
a small space that affects blood flow to
a vital organ. Regardless of service line,
each patient can react in an adverse
manner to the medication or procedural
intervention when sedated or asleep.
They may have had five other surgical
procedures, and this time something
abnormal happens. Sometimes in the
OR, we as staff get very complacent because
we do it all day long. We always
have to keep in mind that what we do is
really critical and remind ourselves each
time that each procedure is important
and could have complications.
ASCs must meet the same emergency
supply standards that a hospital
does. They perform drills for malignant
hyperthermia, cardiac and respiratory
issues, pediatric emergencies, and all
other environment of care emergencies.
Moving more acute care procedures
into the surgery center world has broadened
our attention to the given patient
population and selection criteria. Before
we think about adding a service line-
whether it is total joint, spine procedures,
or cardiac procedures-we work
closely with anesthesia and surgeons.
They must understand appropriate patient
selection criteria.
In our cardiac centers, such patient
criteria may be a little bit different than
someone coming in for an orthopedic
treatment. At our ASCs, when performing
cardiac and peripheral vascular
procedures, we have added medications
to our formularies and items we
may not normally have in the surgery
SURGERY CENTERS
BY JENNIFER LUBELL
center. Centers performing peripheral
vascular and cardiac procedures will
have a greater variety of anticoagulants
and reversal medications. Instead of
only first line cardiac medications on
the crash cart, second line and other
specific medications will be in place in
these rooms. Detailed emergency supply
conversations are initiated with providers.
" Do I need a balloon pump here
in the center just in the event we have
an artery that dissects, or Femostop for
femoral bleed, " for example.
These are the conversations you have
before you start any service line addition.
Some procedures are very safe; others
you would not want to do. It is key to
understand the procedures in the populations
and the comfort levels of providers.
Q: What do ASCs need to know
about state regulations and
cardiac procedures?
Understand your state regulations.
States have finite, specific certificate of
need (CON) rules that may be difficult
to understand. Medicare might say you
could do something, but the state may
not permit it. One item may be related
to thresholds on how much money you
can spend, or where cardiac procedures
can be done. Or, you cannot buy cardiac
equipment if it is related to a cardiac
catheterization lab. You must understand
each state's rules. Some of them have a
little bit of a loophole, others do not.
In Michigan, for example, you can
do extremity vascular interventions but
no other cardiac procedures. California
allows cardiac rhythm therapy (CRT) but
no percutaneous coronary intervention
in the ASC. Georgia does not allow electrophysiology
or CRT implants. In Pennsylvania,
ASCs cannot do peripheral
artery disease treatment.
In several states we have seen legislatures
or lawmakers go back and try to
change the CON and state statutes-especially
as COVID-19 looms and hospitals
are limited with elective procedures.
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OR Manager April 2022
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