CV increasingly is an ambulatory business. More CV services are shifting outpatient, more services can be performed in ambulatory sites, and there’s more competition from freestanding facilities. While we know hospital leaders across the country are setting big goals for expanding their ambulatory footprint and service offerings, CV may not be there quite yet as CV leaders historically have had limited purview and responsibility for services provided off the hospital campus.

But today’s priorities make it virtually impossible for the service line to ignore the ambulatory setting. Payers and patients are looking for lower-cost sites, you are looking for lower-cost ways to deliver care, and you’re seeing greater competition for market share from ambulatory facilities.

The resources below provide a primer for the most important policies and market trends shaping this shift, tools to support ambulatory service placement decisions, and best practice case profiles from CV programs that have shifted both noninvasive services and procedures off the hospital campus.

Get smart on the changing ambulatory market

1. Learn about site-neutral payments using the site neutral payment cheat sheet
2. Understand Medicare payment programs—including IPPS, HOPPS, MFPS, and MACRA—in the Medicare payment program cheat sheets
3. Keep up with policy changes by reading our recent blog posts, including:
4. Our take: a federal judge just struck down Medicare's site-neutral payment rule
5. 3 things to know about CV ambulatory changes for 2020
6. Medicare Hospital Outpatient Payment update: Final Rule CY 2020

Determine appropriate placement of noninvasive diagnostic services

1. Cardiovascular Price Shift Calculator tool
2. Review case profiles for how other programs have shifted noninvasive diagnostic services off campus:
3. Stanton Health (a pseudonym) developed a shared CV and oncology HOPD facility to provide an integrated approach to multidisciplinary outpatient care
4. WellStar Health System built a series of off-campus health parks for physician offices, diagnostics, and other core services to improve patient access and provide new net growth for the system
5. UC San Diego Health incorporates patient feedback when evaluating site-of-service changes and outpatient pricing
6. UVA Health developed a comprehensive CV ambulatory facility off the hospital campus

Evaluate opportunities for off-campus procedures

1. Watch the on-demand webconference, CV Procedures in ASCs, or download the slides to get more information on the shift of procedures to freestanding facilities.
2. Read our expert insight, Five things to consider before you start a vein clinic
3. Review case profiles to learn how other programs evaluated opportunities to offer off-campus procedures based on their market:
4. Verona Hospital (a pseudonym) evaluated ASC investment based on physician interest but decided not to develop an ASC after evaluation
5. AtlantiCare leveraged existing system ASCs to move lower-acuity CV procedures
6. AdventHealth Central Florida Division developed a new CV ASC as part of a joint venture with local independent physicians

Your next steps

In light of this shift, CV leaders have a few options to consider moving forward. You can double down on your HOPD strategy—improve operational efficiencies to reduce costs and increase access. You can partner with existing ambulatory sites to improve alignment with physician practices and ideally capture downstream volumes. Or you can move first, and open new ambulatory facilities in your market to attract patients and physician talent.

There’s no one right answer here, and you may need to re-evaluate the path you choose based on future changes in your market. But whether you agree with this freestanding shift or not, it’s happening. You need to have a proactive strategy to how you will respond, or else your program may be left behind.

Want to discuss your strategy with our expert team? Email us at cardiovascular@advisory.com