Imaging in ambulatory surgical centers and office-based labs
December 08, 2020
By David Pacitti
It’s a trend in U.S. healthcare that’s as intriguing as it is undeniable: More and more surgical and minimally invasive procedures that involve medical imaging are migrating to outpatient settings outside the hospital. In entities known as ambulatory surgical centers (ASCs) and office-based labs (OBLs), physicians now regularly perform image-guided procedures that include — but aren’t limited to — diagnostic catheterizations, percutaneous coronary interventions, and rhythm management.
Far from new, ASCs and OBLs (the latter are also known as office interventional suites, or OISs) have existed for roughly 40 years, performing a variety of lower-acuity surgical procedures. They arose when Medicare and other payers realized the financial impact of moving certain lower-acuity procedures from higher-acuity hospital inpatient and outpatient settings to environments where an operating room procedural minute is less expensive. About 10 years ago, imaging began making major inroads in ASCs and OBLs when these entities began performing markedly greater numbers of peripheral vascular interventions. A 2014 report from the Office of Inspector General affirmed that moving select lower-acuity procedures to ASCs — and reimbursing them at rates lower than hospitals — could save Medicare and its beneficiaries billions of dollars.
The differences between an ASC and an OBL can be difficult to define. The Centers for Medicare & Medicaid Services (CMS) classifies an ASC as a “facility-based place of service” — a designation shared by inpatient and outpatient hospitals, skilled nursing facilities, and military treatment facilities. CMS regards an OBL as a “non-facility-based place of service,” alongside public and rural health clinics as well as mobile health units. Don’t assume from this classification that OBLs only handle the most low-acuity surgical procedures, however; clinical and regulatory environments for ASCs and OBLs differ, and some OBLs may perform ASC-type procedures due to negotiations with private payers.
Benefits of ASCs and OBLs may extend beyond payer cost savings. As partial or total owners of these places of service, physicians can enjoy greater autonomy and job satisfaction by returning to a private practice-type setting. Patient benefits are significant. Since emergent, high-complexity cases can’t disrupt scheduling, pacemaker patients don’t spend hours in the waiting area while physicians treat newly arrived heart attack patients. Even the patient’s long walk from a hospital’s sprawling parking area to its front door is eliminated, reducing patient anxiety. Because patients no longer need to navigate a multistory hospital building or multiacre medical campus, they are less likely to be late for appointments. Finally, patients may find comfort in the idea of having their procedure performed at a site that isn’t also treating COVID-19 patients.
Of course, inpatient and outpatient hospital settings remain essential. In addition to intensive patient observation and overnight stays, they provide greater access to surgical backup teams and other emergent services. And as more routine imaging-guided procedures shift to ASCs and OBLs, hospital physicians can focus on highly complex, critical care procedures, including structural heart and neurovascular cases.
Continued growth in ASCs and OBLs over the next five to 10 years is predicted. However, that growth’s amplitude and velocity hinge on the degree to which each state’s regulatory bodies embrace this concept of free market healthcare. Some states restrict certain procedures in ASCs and OBLs regardless of whether Medicare reimburses for them.
In terms of emerging procedures in these places of service, expect interventional cardiology to take root alongside diagnostic cardiology. Image-guided procedures that have become firmly established in ASCs and OBLs may begin to incorporate advanced technologies such as 3D imaging and robotics.
Lower-acuity, image-guided procedures certainly appear to have found solid footing in ASCs and OBLs, with the golden trifecta of patients, physicians, and payers all slated to benefit from this migration.
About the Author: David Pacitti is president and head of the Americas at Siemens Healthineers.
It’s a trend in U.S. healthcare that’s as intriguing as it is undeniable: More and more surgical and minimally invasive procedures that involve medical imaging are migrating to outpatient settings outside the hospital. In entities known as ambulatory surgical centers (ASCs) and office-based labs (OBLs), physicians now regularly perform image-guided procedures that include — but aren’t limited to — diagnostic catheterizations, percutaneous coronary interventions, and rhythm management.
Far from new, ASCs and OBLs (the latter are also known as office interventional suites, or OISs) have existed for roughly 40 years, performing a variety of lower-acuity surgical procedures. They arose when Medicare and other payers realized the financial impact of moving certain lower-acuity procedures from higher-acuity hospital inpatient and outpatient settings to environments where an operating room procedural minute is less expensive. About 10 years ago, imaging began making major inroads in ASCs and OBLs when these entities began performing markedly greater numbers of peripheral vascular interventions. A 2014 report from the Office of Inspector General affirmed that moving select lower-acuity procedures to ASCs — and reimbursing them at rates lower than hospitals — could save Medicare and its beneficiaries billions of dollars.
The differences between an ASC and an OBL can be difficult to define. The Centers for Medicare & Medicaid Services (CMS) classifies an ASC as a “facility-based place of service” — a designation shared by inpatient and outpatient hospitals, skilled nursing facilities, and military treatment facilities. CMS regards an OBL as a “non-facility-based place of service,” alongside public and rural health clinics as well as mobile health units. Don’t assume from this classification that OBLs only handle the most low-acuity surgical procedures, however; clinical and regulatory environments for ASCs and OBLs differ, and some OBLs may perform ASC-type procedures due to negotiations with private payers.
Benefits of ASCs and OBLs may extend beyond payer cost savings. As partial or total owners of these places of service, physicians can enjoy greater autonomy and job satisfaction by returning to a private practice-type setting. Patient benefits are significant. Since emergent, high-complexity cases can’t disrupt scheduling, pacemaker patients don’t spend hours in the waiting area while physicians treat newly arrived heart attack patients. Even the patient’s long walk from a hospital’s sprawling parking area to its front door is eliminated, reducing patient anxiety. Because patients no longer need to navigate a multistory hospital building or multiacre medical campus, they are less likely to be late for appointments. Finally, patients may find comfort in the idea of having their procedure performed at a site that isn’t also treating COVID-19 patients.
Of course, inpatient and outpatient hospital settings remain essential. In addition to intensive patient observation and overnight stays, they provide greater access to surgical backup teams and other emergent services. And as more routine imaging-guided procedures shift to ASCs and OBLs, hospital physicians can focus on highly complex, critical care procedures, including structural heart and neurovascular cases.
Continued growth in ASCs and OBLs over the next five to 10 years is predicted. However, that growth’s amplitude and velocity hinge on the degree to which each state’s regulatory bodies embrace this concept of free market healthcare. Some states restrict certain procedures in ASCs and OBLs regardless of whether Medicare reimburses for them.
David Pacitti
Lower-acuity, image-guided procedures certainly appear to have found solid footing in ASCs and OBLs, with the golden trifecta of patients, physicians, and payers all slated to benefit from this migration.
About the Author: David Pacitti is president and head of the Americas at Siemens Healthineers.