Ambulatory Surgery Centers with Innovative Technologies are transforming the legacy healthcare delivery model.

By Ryan Aldridge, Senior Vice President at Atlas Healthcare Partners

Quote: “Cardiovascular physicians expect a higher level of clinical experience and qualification, quality, clinical safety, and cardiovascular specific workflow excellence in an ASC setting due to the unique risks and patient complexities. A Strong clinical safety and quality program is essential to achieve this.”

Ryan Aldridge is the Senior Vice President of Strategy & Growth at Atlas Healthcare Partners and a diligent and versatile healthcare professional. He is responsible for New Health System Joint Ventures, ASC network and market strategies, and in-market organic growth of case volumes and revenues across the enterprise portfolio of ASCs at Atlas Healthcare Partners.

In an interview with MedTech Outlook, Aldridge highlights the growth of cardiovascular services in ambulatory surgery centers (ASC) by leveraging evolving healthcare technologies.

Can you discuss the key aspects of a recent project or initiative you have worked on?

Our company is primarily focused on the development of ASCs. We have observed a significant shift in the types of medical procedures offered at ASCs. This includes minimally invasive spinal procedures, treatments for peripheral arterial diseases, peripheral coronary intervention, cardiac ablation, and electrophysiology utilizing specialized imaging specific to vascular and cardiology services. Technological advancements like ASC viable fixed imaging equipment, intravascular ultrasound, and stents viable for peripheral vascular procedures in the outpatient space make these advanced treatments increasingly available in ASCs.

Medicare has recently approved peripheral coronary intervention (PCI) procedures and electrophysiology interventions in ASCs. Electrophysiology procedures like pacemaker internal pulse generator replacements and loop recorders are now performed in ASCs. There is a strong possibility that CMS approves cardiac ablation procedures as soon as 2025. These are not commonly performed in ASCs today as they are not currently covered by CMS and may only be performed on patients with commercial insurance plans that have coverage and reimbursement carved out for ASCs. Approval of ablation procedures would accelerate the shift of even more CV cases from the Hospital and HOPD settings to the ASC site of care. This could lead to medical technology vendors needing to pivot their portfolio strategy by targeting cardiovascular ASCs for their ablation devices, marking a substantial shift in case volumes from traditional hospital settings. Imaging industry behemoths like Siemens, Philips and GE have already begun adopting this change through strategic partnerships with companies like Medtronic, Boston Scientific, and Abbott to partner on imaging and implantable product offerings with varied economic incentive models. The migration of cardiovascular in addition to all types of services from hospitals to surgery centers is bringing an increased focus on value-based care and pricing strategies that are at the intersection of increased value with equal or improved patient outcomes.

What are the current challenges of performing cardiovascular surgery in ASCs?

Integrating interventional cardiology procedures into an existing ASC can be challenging due to the high service line start up cost of fixed imaging equipment and the differing workflows and additional clinical experience necessary to serve cardiovascular physicians and their patients, which may not be economically feasible for multi-specialty ASCs. Further these ASCs may not be able to recruit the clinical subject matter experts with credentials essential to cardiovascular care delivery. The fastest growing ASC type for cardiovascular services development involve single-specialty cardiovascular ASCs where they can invest in large equipment like fixed CT imaging devices. Fluoroscopy machines with an upgraded cardiovascular package for increased image resolution can also be adequate for certain cardiovascular procedures. Intravascular ultrasound may also be used for peripheral vascular cases to guide stent placement and/or replacement.

Even with the advent of emerging technologies, ensuring seamless workflows is critical to the success of cardiovascular procedures in ASCs. Cardiovascular physicians expect a higher level of clinical experience and qualification, quality, clinical safety, and cardiovascular specific workflow excellence in an ASC setting due to the unique risks and patient complexities. A Strong clinical safety and quality program is essential to achieve this. Experienced clinical staff, strong leadership, dedicated training programs for nursing staff, and on-site leaders are conducive to high-quality results within the cardiovascular space.

The shift of minimally invasive procedures to surgery centers will allow quicker recovery times, reduced scarring in procedures, improved patient and physician satisfaction, lower cost of care, and better patient outcomes. Indeed, these are the primary goals of the quadruple aim of healthcare which is why this is megatrend.

How do you see the growth of ASCs over the next ten years?

Currently, hospitals and health systems face challenges in retaining both their employed and independently aligned cardiovascular physicians which means that they are at direct risk of decreasing case volumes.  This risk increases every year as CMS continues to review and revise the list of procedures eligible for ASCs. Cardiovascular physicians are preferring to perform these cases in ASCs for a multitude of reasons involving cost, quality, and experience. Other market forces driving these changes are changing physician employment operating models, physicians as investors in ASCs, venture capital and private equity accelerating platforms in healthcare, and managed service organizations. These players and models seek emerging opportunities and collaborations with physician groups to develop innovative delivery models involving ASCs which are situated outside of hospitals. Consequently, many hospitals are choosing to respond by establishing their own ASCs and collaborating with management companies or physicians to increase effectiveness and alignment of the overall platform. The next five years are expected to advance ASC services, with additional CMS approvals for ASC eligible procedures anticipated in subsequent years, indicating continued expansion of cardiovascular services in surgery center settings in addition to other traditionally higher acuity hospital surgical and procedural services like spine and total joints.  The legacy hospital operating model is evolving in real time and recent data demonstrates that hospitals with an ASC network have healthier balance sheets and net income since rebounding from COVID.

What is the impact of technology and digital tools in the medtech space?

The MedTech space is evolving rapidly, with increasing innovation of implanted devices, big data aggregation and artificial intelligence to collect and analyze data. Atlas has chosen to partner with Kythera Labs to analyze claims data and specialist provider utilization behavior. This enabled us to build a strategic analytics dashboard and aided us in developing high velocity patient continuum pathways for patients across the outpatient continuum of care for all service lines. Further, it has assisted our teams in assessing clinical risk for patients earlier and optimizing clinical workflows, staffing models and procurement of products in our ASC portfolio. The improved data analytics helps Atlas bend the cost curve for patients and payers while providing an environment where physicians may do their highest quality and most efficient work, elevating patient outcomes simultaneously. Integrating artificial intelligence and analytics with clinical decisions promotes patient-centric care and enhances population health management capability.

By combining the right analytical tools, quality data, and claims and remittance data, along with an optimized environment of care for implanted devices we have been able to help hospitals, health systems and their health networks develop an improved facility and provider network of specialists with improved alignment, efficiency, and network coverage. We also help physicians understand these metrics to align closer with health systems and serve the right patient populations ultimately helping their practices grow.  These types of payer and provider partnerships seek to align quality and economic incentives for all of the parties involved ultimately leading to more coordinated and seamless patient care corresponding to improved outcomes across the population.