The Fight Continues: CMS’s 2024 Decision on Cardiac Electrophysiology Procedures in ASCs
Today, CMS released the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule, detailing the procedures approved for ASC coverage in 2024. Despite concerted efforts by the Arrhythmia Intervention Society (AIS) and our allies in the field, cardiac electrophysiology (EP) procedures, including critical interventions such as ablations, electrophysiological studies, and cardioversions, were not included in the ASC Covered Procedure List (CPL). This decision is disheartening for our community, as it limits access to essential cardiac care that could be safely provided in the ASC setting.
Understanding the CMS Decision
In its response, CMS acknowledged reviewing clinical data, public comments, and experiential evidence to assess the suitability of various cardiac EP procedures for the ASC setting. Although several dental procedures were added to the CPL, CMS ultimately declined to include EP procedures, citing the need for active medical monitoring after certain procedures and the perception that some EP interventions are too complex for ASC settings.
For instance, CMS stated that “many of these codes have associated inpatient admissions, where the beneficiary requires active medical monitoring and care at midnight following the procedure.” Additionally, CMS noted that cardioversions and echocardiographic procedures were considered ineligible due to their non-surgical nature and, therefore, did not meet the qualification criteria for ASC coverage.
Why EP Procedures Should Be Included on the CPL
AIS believes that many EP procedures, including catheter ablations for atrial fibrillation and ventricular tachycardia, are not only appropriate for ASCs but can also improve the quality of care for patients by offering a less restrictive, more accessible setting. Here’s why we are advocating for their inclusion:
Patient Access and Convenience: Ambulatory surgical centers provide a more accessible setting for patients, often with shorter wait times, reduced facility fees, and a more comfortable environment compared to hospitals. Expanding the ASC CPL to include EP procedures would make critical cardiac care more accessible, especially for patients in rural or underserved areas.
Cost Efficiency: Procedures performed in ASCs are typically associated with lower costs due to reduced overhead, without compromising safety. Including EP procedures on the CPL could reduce overall healthcare spending and provide significant cost savings for both patients and the healthcare system.
Safety and Feasibility: Research and clinical data support the safety of many EP procedures in the ASC setting. Advances in procedural techniques and technology have made EP interventions less invasive, shortening recovery times and minimizing the need for post-procedure monitoring. Numerous clinical studies demonstrate that ASCs can provide safe, effective environments for EP procedures when proper protocols and resources are in place.
AIS's Ongoing Advocacy and Next Steps
This CMS decision does not mark the end of our advocacy—it’s a call to action. At AIS, we are committed to ensuring that the full spectrum of EP care is accessible in the most suitable settings for our patients. We will continue gathering clinical evidence, engaging with policymakers, and collaborating with stakeholders to advocate for these procedures. Here are some of the next steps we will take:
Data Collection and Research: We are working on collecting robust clinical data on the safety and efficacy of EP procedures in the ASC setting. Our goal is to compile a comprehensive body of evidence that supports the feasibility of these procedures outside traditional hospital environments.
Engagement with CMS and Stakeholders: AIS will work closely with CMS, other medical societies, and advocacy groups to present our findings and advocate for the inclusion of EP procedures on the CPL in future rulemaking cycles. By maintaining open dialogue and providing evidence-backed arguments, we aim to shift policy in favor of increased access to cardiac care.
Community and Member Involvement: We invite our members and supporters to join us in advocating for this cause. Through grassroots efforts, testimonials, and case studies, we can amplify our voices and highlight the real-world impact that accessible EP care in ASCs would have on patients and healthcare providers.
How You Can Help
If you are an AIS member, electrophysiologist, or someone who has benefitted from cardiac procedures, we encourage you to get involved. By sharing your experiences, supporting our advocacy campaigns, and helping us gather data, you can contribute to a future where critical EP care is available to more patients in ASCs. We also invite you to reach out to your representatives and express the importance of expanding access to these life-saving procedures.
Final Thoughts
At AIS, we are deeply invested in the future of electrophysiology and patient-centered care. Although we are disappointed with CMS’s decision, we remain resolute in our mission. The fight to expand access to cardiac EP procedures in ASCs continues, and together, we can advocate for meaningful changes that improve healthcare for all.
We thank our community for your ongoing support and urge you to stay tuned for updates as we work towards our shared goals. This journey may be challenging, but with persistence and unity, we believe that change is not only possible—it is inevitable.