The ASC Shift
The opportunity is growing, but success depends on more than procedural eligibility. Four strategic questions can help leaders determine whether ambulatory cardiovascular care makes sense in their market.
Cardiovascular care is increasingly moving beyond the hospital walls, but many organizations are approaching the transition with the wrong mindset.
Instead of questioning if more cardiovascular procedures can be performed in ambulatory settings, leaders should ask: Which patients, physicians, procedures, and markets are ready for a safe and sustainable ambulatory cardiovascular strategy?
For years, much of the industry's shift toward outpatient cardiovascular care has reflected a change in patient status more than a true change in site of care. Patients may have gone home the same day, but procedures were still commonly performed in hospital outpatient cardiac catheterization labs and electrophysiology (EP) labs. Vizient Strategic Intelligence indicates that approximately 90% of cardiac ablations and nearly 50% of percutaneous coronary interventions (PCIs) so far in 2026 are still performed in hospital outpatient departments (HOPDs). While those procedures may be labeled outpatient from a reimbursement perspective, they remain largely hospital-based from an operational standpoint.
But the market structure is changing. Policy shifts, payer pressure, physician alignment strategies, and growing demand for convenient care are creating new opportunities to move cardiovascular procedures into ambulatory surgery centers (ASCs), office-based labs (OBLs), and hybrid care models. Recent Centers for Medicare & Medicaid Services (CMS) decisions expanding procedural eligibility have only accelerated that discussion.
However, reimbursement alone will not determine success. Unlike many traditional ASC specialties, cardiovascular care brings significant clinical, operational, and capital complexity. Cath labs and EP programs require specialized staffing, radiation shielding, imaging infrastructure, anesthesia support, device inventory management, transfer protocols, and strong physician governance. Moving procedure volumes outside the hospital requires a strategic redesign of the cardiovascular system of care.
To succeed, organizations must evaluate ambulatory cardiovascular opportunities through four lenses: clinical readiness, regulatory environment, physician alignment, and financial sustainability.
Not every cardiovascular procedure is ready to migrate, and not every organization is ready to support it.
Today, many cardiovascular procedures remain concentrated in HOPDs and inpatient settings, even when they are technically classified as outpatient procedures. Diagnostic catheterizations, percutaneous coronary interventions (PCI), pacemaker procedures, and implantable cardioverter-defibrillator (ICD) implants still have relatively limited ASC penetration nationally, while peripheral endovascular procedures have moved more readily into office-based settings.
At the same time, demand continues to grow. The Vizient 2026 Impact of Change® forecast projects outpatient cardiovascular volumes will increase significantly over the next decade, with 10- year outpatient growth (+29%) outpacing inpatient growth (+13%). That growth will create both capacity challenges and opportunities to shift appropriate care into lower-acuity ambulatory settings.
Orthopedics provides a useful precedent, albeit based on inputs into when and how those procedures moved off campus. Procedures once considered hospital-dependent successfully migrated as technology, reimbursement models, and clinical pathways evolved. Cardiovascular care is beginning to follow a similar trajectory, but with a higher operational threshold. The infrastructure, staffing requirements, and risk profile associated with many cardiovascular procedures require more deliberate planning and patient selection.
Take PCI as an example. The Society for Cardiovascular Angiography & Interventions supports percutaneous coronary interventions without on-site surgical backup when patient selection, operator experience, and facility preparation meet established standards. That doesn’t mean every PCI belongs in an ASC. Instead, organizations should have more nuanced conversations about which patients, procedures, and facilities are best suited for ambulatory care.
The same principle applies to electrophysiology. EP is often viewed as one of the most promising opportunities for cardiovascular ASC growth because of rising demand, advancing technology, and standardized recovery pathways. Yet EP programs also require significant investments in mapping systems, anesthesia support, specialized staffing, and escalation protocols.
Successful ambulatory EP strategies begin with carefully selected procedures and standardized workflows rather than attempts to replicate the full hospital EP environment.
National trends can be misleading. The pace of ASC adoption varies from market to market. Certificate-of-need regulations, payer policies, physician ownership structures, competitive dynamics, population growth, and the presence of national ASC operators all influence what is possible. In some markets, ambulatory surgery remains relatively underdeveloped. In others, ambulatory sites already account for a significant share of procedural volume.
Before investing in a new ASC, organizations should assess whether the greater opportunity lies in expanding an existing ambulatory footprint, improving same-day discharge programs, optimizing hospital-based labs, or pursuing a hybrid model.
Physician alignment may be the most important variable in determining success.
Cardiologists today have more options than ever. Some are employed by health systems. Others remain independent or are being approached by private equity-backed platforms, national ASC operators, and specialty management organizations. Their priorities vary as well. Some physicians seek ownership opportunities and greater autonomy. Others place higher value on operational support, predictable scheduling, and reduced administrative complexity.
Health systems must address these realities directly. If they do not create compelling alignment models, competing organizations likely will.
The discussion should move beyond facility ownership and focus instead on governance, clinical leadership, operational efficiency, and shared strategic objectives. Strong physician engagement early in the planning process often is the difference between successful ambulatory expansion and underutilized assets. Additionally, even if you were to build an ASC, would your clinicians and workforce want to staff it? Challenges can arise with employed physicians going to a site that does not have the support/resources they are used to.
The financial opportunity of shifting cardiovascular care to ambulatory is real, but it requires disciplined analysis.
Lower-cost sites of care can create value for patients, payers, and providers. However, lower reimbursement rates, high-cost devices, supply chain variability, and workforce shortages can quickly erode projected margins.
This is why organizations should avoid building business cases around a single procedure category or best-case volume projections. A portfolio approach is more resilient, evaluating interventional cardiology, electrophysiology, and vascular procedures collectively based on payer mix, physician commitment, utilization patterns, capital requirements, and long-term demand.
CMS continues to accelerate the migration of care to lower-cost settings through a series of proposed payment and coverage changes. Under the 2027 Outpatient Prospective Payment System (OPPS) proposed rule, for the second phase of the inpatient only (IPO) list elimination, the agency would remove 638 services from the IPO list beginning Jan. 1, 2027. The third and final phase of the IPO list elimination is still slated for Jan. 1, 2028. CMS indicates that the services for the last phase includes many of the nation's highest-acuity services, such as cardiovascular procedures, organ transplants, craniotomies, and other complex surgical interventions.
Similar to the agency’s decisions for CY 2026, CMS proposes to expand the ASC Covered Procedures List by adding hundreds of procedures, including many the agency proposes to remove from the IPO list. In addition, CMS proposes site neutral payment policy for imaging without contrast services for certain excepted off-campus provider-based departments, further reinforcing its broader policy direction toward lower-cost care delivery.
For health systems, ambulatory migration can feel threatening because cardiovascular services have historically generated significant hospital revenue and downstream activity. But resisting that migration is not a strategy.
A stronger approach is to view ambulatory sites as part of an integrated cardiovascular network rather than competitors to the hospital. As commercial payers increasingly require appropriate procedures to be performed in ASCs instead of hospital outpatient departments, many health systems are pursuing ASC partnerships or acquisitions to remain aligned with reimbursement expectations while preserving continuity of care. Lower-acuity procedures can move into ambulatory settings, creating capacity for more complex cases that require advanced resources, multidisciplinary support, and inpatient capabilities. Done well, an ambulatory cardiovascular strategy can improve access, strengthen physician alignment, and reinforce the hospital's role as the center for high-acuity care.
Workforce realities make this integrated approach even more important. Cath lab nurses, EP technologists, radiologic technologists, and cardiovascular anesthesia professionals remain in short supply in many markets. Opening a new ambulatory site without a sustainable staffing plan may simply relocate existing constraints rather than solve them.
For some organizations, the highest-priority investment may not be a new facility at all. It may be stabilizing staffing, improving scheduling practices, reducing turnover, and creating more consistent care pathways across existing sites of care.
Success requires a clear understanding of market dynamics, strong physician alignment, realistic assessments of case-shift potential, robust safety protocols, workforce readiness, and disciplined decisions about where to invest and compete.
Cardiovascular care is moving beyond the hospital walls, but the transition won’t look the same in every market. The future cardiovascular platform will be defined by how effectively organizations connect hospitals, HOPDs, ASCs, OBLs, and physician practices into a coordinated system of care.
Associate Principal, Intelligence
As a key member of the Vizient Intelligence team, Aaker leads cardiovascular thought leadership by analyzing the impact of emerging trends, technologies and clinical advancements on care delivery. In addition to his national perspective, he provides direct support to clients through custom intelligence and on-site engagements, helping organizations navigate complex challenges and uncover strategic growth...
Senior Vice President, Physician Preference
As vice president, category management at Vizient, Allen Passerallo is an accomplished healthcare supply chain leader with extensive expertise in sourcing, value analysis and purchasing. He has held senior leadership roles at Cleveland Clinic and Johns Hopkins Health System, where he advanced value-based care strategies and delivered significant cost savings. During his decade at Cleveland Clinic, Passerallo led initiatives that...
