As procedures migrate to the outpatient setting, ASC leaders are seeing cardiology and orthopedics as huge opportunities for growth.

Cardiology procedures received the highest estimated Medicare payment increases in 2021, making it the fastest growing ASC specialty, according to Avanza's "2022 Key ASC Benchmarks and Industry Figures" report. Orthopedics is the most common specialty for ASCs in 2022, according to March data from the ASC Association.

"As CMS allows more procedures to be performed in centers, it gives centers the option to be open for more procedures," Catherine Retzbach, BSN, RN, director of ASC operations at Marlton, N.J.-based Virtua Health, told Becker's. "Cardiology and spine procedures offer patients more options to have procedures be performed in a high-quality, low-cost environment."

High acuity procedures, such as those in cardiology and orthopedics, offer a massive financial opportunity for ASCs, if they can cover the costs of technology and other expenses.

ASC chains are also looking at high acuity procedures. By the end of the third quarter, orthopedic and spine procedures made up 20 percent of ASC chain United Surgical Partners International's volume.

In an Oct. 20 earnings call, Saum Sutaria, MD, CEO of Tenet Healthcare, USPI's parent company, said the chain is doubling down on its high-acuity growth strategy. He cited growth at an ASC in Tennessee, where the center boosted revenue by 46 percent by replacing high-volume, low-acuity procedures with high-acuity orthopedic cases.

Additionally, earlier this year, Brentwood, Tenn.-based Surgery Partners inked a deal with ValueHealth to expand access to high-value surgical care and capitalize on cardiology's migration to the outpatient setting.

Some payers are getting on board. Aetna dropped its policy to not cover cardiac PET/CT scans in July, and CMS recently added several cardiac procedures to the ASC covered procedure list, including diagnostic and interventional coronary procedures, peripheral vascular interventions, and placement of pacemakers and defibrillators.

"The future looks bright for more total joint cases in the ASC, along with spine and cardiology. However, insurance carriers will need to revisit the procedures previously only allowed in the hospital setting to create an easy transition to ASCs," Brenda Carter, administrator of Wilmington (N.C.) Surgcare, told Becker's. "As the carriers have historically been slow to respond to changing trends, this may initially present some challenges.

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