Ambulatory Surgery Centers in Cardiac Electrophysiology: Current Status and Future Directions

Ambulatory surgical centers (ASCs) are rapidly expanding their role in cardiac electrophysiology (EP). Several studies have demonstrated that they provide comparable safety, effectiveness, and efficiency to hospital settings for elective, nonacute EP procedures. ASC's provide superior patient-centered care with increased convenience, improved access, operational efficiency, and cost savings, which might potentially mitigate delays in EP procedures and improve patient outcomes. Use of appropriate patient selection criteria, standardized workflows, protocols for same-day discharge, and transfer agreements are key for the success of ASC's. However, there are several challenges. The need for Certificate of Need and other regulatory barriers in several states, as well as variability in private insurance coverage, may impede widespread adoption of ASC's. The shift of low-risk, high-margin procedures to ASC's may disrupt the revenue cycle of the health care systems, impacting other service lines. Although physician ownership in ASC's can be a source of increasing technical revenue, the upfront costs and operational challenges may motivate them to partner with private equity firms, thereby decreasing their autonomy and available resources. It is important to track the patient selection and outcomes with a standardized EP-ASC registry overseen by medical professional societies. The current ACC EP leadership perspective article discusses the pros and cons of EP ASC's from the viewpoint of patients, physicians, health care systems, and insurance payors. In addition, it also provides best practices, patient/case selection criteria, and an insight into the future directions of EP ASC's.