Pioneering Vascular Surgery: The Rise of Office-Based Labs and ASCs
Vascular surgery, a field renowned for its precision and innovation, is on the cusp of a remarkable transformation. Recent shifts in market dynamics and regulatory policies are steering vascular procedures toward cost-effective settings, with office-based labs (OBLs) and ambulatory surgery centers (ASCs) emerging as the vanguard of this revolution.
This transformation gained substantial momentum when the Centers for Medicare and Medicaid Services (CMS) expanded the ASC-covered procedure list (CPL) to encompass diagnostic angiograms and endovascular interventions in 2020. These changes have significantly influenced the landscape of vascular surgery, paving the way for a future where vascular procedures are no longer confined to traditional hospital settings.
The journey toward OBLs and ASCs as preferred settings for vascular procedures began earlier. In 2009, procedures related to peripheral artery disease (PAD) started migrating to OBLs, marking the initial phase of this transition. Subsequently, in 2016, cases related to arterial stents and venous interventions joined this migration. The transition continued with diagnostic angiograms being performed in ASCs in 2019, and a transformative moment arrived in 2020 when Medicare approved endovascular interventions for ASCs. These milestones have reshaped the future of vascular surgery.
Industry experts anticipate that CMS will continue expanding the ASC-CPL to include additional vascular procedures such as complex aortic aneurysm repairs, arteriovenous fistula creations, and thrombectomy procedures. Some ASCs are already performing these procedures on commercial patients, marking a promising trend towards the inclusion of more vascular interventions in the ASC-CPL.
Commercial payers are closely following these changes and aligning their strategies accordingly. Similar to their approach with endovascular interventions before its inclusion in the ASC-CPL, commercial payers are already covering vascular procedures, even before they are included in the Medicare CPL for ASCs. This proactive approach underscores their commitment to cost-effective, high-quality vascular care in OBLs and ASCs.
Medicare has further reinforced this transition by introducing an outpatient procedure price comparison tool. This tool underscores the substantial cost advantages of ASCs. For instance, it highlights that a common diagnostic angiogram procedure (CPT 75685) costs $2,100 in an ASC, with a patient responsibility of $420, compared to $3,800 in a hospital, with a patient responsibility of $760. These cost disparities are compelling payers to incentivize the migration of vascular procedures.
Bundled payment arrangements through Medicare Advantage are evolving, allowing providers to share savings generated from cost differences across various surgical sites of care. This dynamic further accelerates the migration of vascular surgery procedures to lower-cost settings.
Commercial payers are also aligning their strategies with CMS by redirecting a substantial portion of the vascular procedures they cover to these cost-efficient sites of care. Notably, United Healthcare has implemented a vascular prior authorization program aimed at shifting cases from hospital outpatient departments (HOPDs) to ASCs. In ASCs, services are expected to expand to include additional diagnostic and interventional vascular procedures.
These changes, coupled with the rise of physician-owned ASCs and direct contracting entities, are poised to reshape healthcare systems’ care delivery and financial performance. To bridge potential revenue gaps when vascular ASCs become prominent in their region, healthcare leaders must proactively develop comprehensive physician alignment and backfill strategies.
Strategies for Vascular Surgery Excellence:
To thrive amid the transition of vascular procedures to OBLs and ASCs, consider implementing these strategies:
(1) Physician Alignment: Foster collaborations with interventional radiologists, cardiologists, and other specialists. Explore joint ventures in ASCs with both employed and independent vascular surgeons.
(2) Market Differentiation: Develop innovative strategies to distinguish your healthcare system in the market. Leverage your position as a leading vascular program and an integrated health system in the region.
(3) Integrated Approach: Seamlessly integrate your vascular ASC strategy into your overall health system strategy. Align joint-venture vascular ASCs with employed and independent physicians to deliver high-value care.
(4) Effective Marketing: Promote the benefits of your program, including advanced technologies, superior outcomes, patient-centered care, accessibility, and convenience.
(5) Value Pursuit: Actively pursue payer and consumer value across all service sites. Expand programs for complex cases, such as complex aortic aneurysm repairs and arteriovenous fistula creations, to harness the full potential of vascular ASCs.
The transformation of vascular surgery procedures to cost-effective settings reflects a multifaceted shift driven by clinical excellence, financial considerations, and strategic alignment. With a well-conceived strategy, proactive risk management, astute business insight, and effective management, healthcare systems can adapt to these changes while ensuring the highest standards of vascular care. The time to embark on this journey toward the future of vascular surgery is now.