HRS/ACC Give Advice on Ablations in Ambulatory Surgical Centers

A new scientific statement from the Heart Rhythm Society (HRS) and the American College of Cardiology (ACC) lays out guiding principles around the performance of intracardiac ablation procedures in ambulatory surgical centers (ASCs), which have emerged as an alternative to hospital-based delivery of certain medical procedures, like PCI.

The statement, published this week in JACC, comes at a good time. Last week, the US Centers for Medicare & Medicaid Services (CMS) added cardiac catheter ablation to its list of covered procedures when performed in ASCs when it released its 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule.

That decision “was an acknowledgment of how our field has advanced with better safety data, more efficient workflows, and appreciable improvements in technology,” Amit Shanker, MD (St. Lawrence Health System, Potsdam, NY), co-chair of the writing committee for the HRS/ACC statement, told TCTMD.

“For patients, ASCs offer a more streamlined and patient-centric experience,” he said, pointing to shorter wait times and lower out-of-pocket costs. And, he added, “clinicians benefit from ASCs’ predictable schedules, reduced administrative burden, preserved autonomy, and the ability to deliver high-volume, high-efficiency care without the resource intensity of large hospitals.”

The picture isn’t all rosy, however, as “the successful scalability of this model is currently hindered by regulatory fragmentation, workforce recruitment challenges, and existing reimbursement disparities,” Shanker said. “Moreover, in select regions in the United States, a rapid and sustained shift in procedural volumes could paradoxically reduce healthcare access by creating economic and workforce strain on local hospitals.”

The impact will likely vary from region to region, he added, noting that states with lower regulatory hurdles that need to be cleared to perform cardiovascular procedures in ASCs—such as Arizona, Florida, Texas, and California—may be more vulnerable.

To help avoid some of those potential downsides, “our statement therefore calls for collaborative, data-driven policies that expand access and efficiency while safeguarding system-wide capacity for complex and emergent cardiac care,” Shanker said.

Years in the Making

The new statement, which included Samuel Jones, MD (Chattanooga Heart Institute, TN), as co-chair of the writing committee, is more than 3 years in the making, said Shanker. Discussions with CMS about covering ablationsat ASCs started near the beginning of 2023.

While waiting for that to happen, he said, “we wanted to develop a document that provides some guiding principles . . . so that there would be some guardrails and some considerations in terms of patient and procedure selection. But before we embarked upon that, we decided to create a same-day discharge document. We thought that was a necessary foundation because, of course, all patients admitted to an ASC require same-day discharge.” That document was released in April.

This new statement, Shanker said, “was developed to analyze available global clinical data, provide a framework for recommended best clinical practices, and to characterize the evolving reimbursement and regulatory landscape in the context of ASC market dynamics and US fiscal policy.”

It covers three broad areas related to the performance of ablations in ASCs, starting with real-world considerations. Those include issues around patient access, staffing trends, same-day discharge, policies, barriers to adoption, and surveillance for quality assurance, along with evidence of the safety and effectiveness of ablation in the ASC setting.

The authors also outline implementation of a standard operating procedure for ablations in ASCs, touching on ethical considerations; facility, physician, and staffing requirements; patient selection; risk management; and establishment of a quality-driven culture. Finally, they highlight financial implications for patients and physicians and the roles of private equity and private insurance in this area.

One of the main messages is that “these ablation procedures can be performed in appropriately selected patients” in ASCs, Shanker said, noting that the discussion of patient selection is one of the key aspects of the document. There is also an emphasis on the importance of a registry to track outcomes of these procedures in real time.

Overall, “the way that EP care is being administered is at a point of transformation,” driven by improvements in technology, workflows, and procedural techniques “that are now essentially allowing many of these once-complicated procedures to be performed in an outpatient setting,” Shanker said.

That could, he added, “certainly have an impact on improving patient access and making the experience better for the patient.”