New ACC Registry Aims to Track Outcomes at Ambulatory Centers

The American College of Cardiology (ACC) has launched a new registry intended to generate insights into the quality of care provided at ambulatory surgery centers (ASCs) offering cardiac procedures. The CV ASC Registry Suite, announced earlier this week, is inviting ASCs to join the registry to be able to track their patients’ outcomes and compare them to those of other centers offering same-day procedures outside the hospital setting.

The new registry joins others already operating under the umbrella of the National Cardiovascular Data Registry (NCDR), like the CathPCI and AFib Ablation registries, but will be notable for collecting data outside of traditional hospital outpatient sites. The idea is to make data collection and analysis seamless and relevant to physicians already working in ASCs or intending to open one.

Ambulatory labs for cardiac procedures have mushroomed in the wake of recent reimbursement changes, led by the Centers for Medicare and Medicaid Services, permitting operators to be reimbursed for a wider range of catheter-based procedures outside of hospitals, including elective PCI and diagnostic angiography. But because they often operate outside of the typical hospital oversight, ambulatory and office-based labs are garnering increased scrutiny, with regulators and investigators keeping tabs on procedure quality as well as the medical necessity of procedures.

Office-based labs and ambulatory centers can lower costs and ease scheduling for patients needing lower-risk cardiac procedures, and in many cases patients, too, would prefer to not be treated in hospitals. But as with peripheral procedures, which moved out of hospitals before cardiac procedures did, there is the potential for abuse.

The new registry, notes an ACC press release, is intended to track and compare outcomes for diagnostic cardiac catheterization, nonacute percutaneous coronary interventions, and defibrillator and pacemaker implantations.

To TCTMD, NCDR Chief Science Advisor Jeptha Curtis, MD (Yale New Haven Hospital, CT), acknowledged that the registry is voluntary and it’s not clear how eager these smaller, often privately owned labs will be to join an NCDR program. But most physicians, not to mention patients, will want to know that their outcomes are similar to those of other centers, he predicted.

“We really felt that there was a great opportunity here to provide benchmarking for sites, so that they could know how they're performing and how their procedures compare to procedures performed at other hospitals, as well as the outcomes of their teams,” Curtis told TCTMD. “There was a clinical need to provide this type of service and we felt like we were the right organization to make it happen. . . . It’s impossible to judge your outcomes if you don't have benchmarking: you’re left with questions about, are my outcomes good or bad? You really do need good benchmarking to provide that context.”

Down the road, he suggested, payers may decide to tie reimbursement to participation in registries or quality initiatives like this one. “We're not counting on that as driving sites to participate in the registry, but you can certainly envision that down the road,” Curtis said. “Right now, I believe the people that are performing these procedures at an ambulatory center, the interventional cardiologists and electrophysiologists, they really want to know that they’re doing the right thing. So I'm optimistic that there will be enough sites interested to make this work.”

Asked whether there were plans to compare ASC outcomes in this new registry with those of similar procedures being done in a hospital setting, as captured in other NCDR registries, Curtis said that doing so “would make a lot of sense. . . . If we can make it an apples-to-apples comparison, I think that would be useful.”

No sites had signed onto the registry within the first few days of the launch. Curtis predicted it would take time but said he expects physicians will ultimately see the value in tracking their outcomes.

“We owe it to our patients . . . to make sure that their outcomes are as good as or better than they are in hospital,” he said.