The Society for Cardiovascular Angiography and Interventions (SCAI) today issued a position statement on the performance of percutaneous coronary intervention (PCI) in ambulatory surgical centers (ASCs). The document was published in SCAI's official journal, Catheterization and Cardiovascular Interventions.
Earlier this year, The Centers for Medicare & Medicaid Services (CMS) began reimbursement for PCI performed in ASCs in response to data on patient outcomes from observational studies and randomized controlled trials supporting same-day discharge (SDD) after PCI.
One of the biggest stories in interventional cardiology this past year was the initiation of payment by CMS for PCI performed in ambulatory surgical centers or ASC. SCAI recognized the potential for this new rule to decrease cost, improve patient satisfaction and increase physician autonomy."
Lyndon Box, MD, FSCAI, Chair of the Writing Proup and Interventional Cardiologist, West Valley Cardiology Services
The position statement makes recommendations for facility and equipment standards, procedural and periprocedural standards, transfer protocols, and operator standards based on an examination of the evidence for potential benefits and harms. The statement also provides an overview for operators on regulatory considerations.
When defining appropriate treatment in the ASC, the writing groups suggests that diagnostic procedures (ie. left and right heart catheterization, coronary and graft angiography) are appropriate for ASCs. Invasive diagnostic testing that involves intravascular imaging (IVUS and/or OCT) or functional evaluation (FFR and/or resting indices) and coronary angioplasty and stenting were also deemed appropriate.
Notably, the document advises that only patients who are considered appropriate for SDD should be considered for intervention in an ASC. The 2018 SCAI Expert Consensus Document on Length of Stay Following PCI provides guidance on patient suitability for SDD.
Additionally, the writing groups suggests that not all patients that might be suitable for SDD in the hospital setting are appropriate for ASC-based PCI, stating that the ASC setting does not provide the option of easily converting a patient to overnight observation. PCI in patients with high-risk clinical features should be avoided in the ASC setting.
The document concludes that the decision to perform PCI in an ASC should be made in the context of the local healthcare environment, while initiation of an ASC PCI program should require transparent adherence to state and federal regulations and operational standards.
"It is crucial that patients in the ASC receive the same quality of care as those in the hospital setting. The paper covers regulatory issues, standards, protocols, quality assurance and ethics. This paper is a 'must-read' for anyone involved with PCI in an ASC," said Box.