By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Are you tired of hernia and hemorrhoids? Are cataracts and bunions starting to lose their appeal? Have you nailed down total joint and spine cases? Why not raise the bar?

We are creating cardiac cath labs (CCL) within surgery centers with great success. Although it is not for every facility and certainly not for the faint of heart, it is a viable marketing and financial option for many.

Every state has different regulations for establishing a cath lab, so you might want to study your state’s code before you start your planning process.

The process, while seemingly complex, really isn’t. The typical model requires the establishment of a CCL as an outpatient treatment center or some other model. The interesting part is that the CCL can be a part of the ASC. The catch is that the two entities cannot function at the same time in your ASC. If you are performing CCL procedures, then you cannot run the ASC concurrently and vice versa. For some very busy facilities, this might be a deal killer. My guess is that some of the thousands of ASCs out there might make it work.

A CCL does not require Medicare certification, and there is not a “facility fee.” Surgeons that use the CCL function under their current professional services would bill for the procedures performed in the CCL, not the ASC. The surgeons receive a “bundled fee” for their services that pay upward of 10 times their current professional fee if these can be performed in the CCL. That obviously makes it very exciting to most cardiac surgeons. There are a lot of minutiae involved in setting that part up, but it is worth it.

So, what’s in it for the surgery center? There are many procedures that the cardiologist can perform in the surgery center when the facility is not used as a CCL. Some of those procedures have a Medicare reimbursement upward of $26,000. Bear in mind that the fee will cover the devices the cardiologist will be inserting, such as pacemakers, defibrillators, or combinations that can cost as much as $22,000. So, it is not a huge windfall. However, by creating a CCL, your facility can add several hundred of the ASC-reimbursed procedures that you probably would never get if you didn’t work with the cardiac surgeons.

A CCL also can be set up independent of an ASC, but many readers may not choose that option.

The equipment cost for a CCL can run as high as $3-5 million. However, a CCL tends to hold its value so you are not going out and replacing it every other year. The supply cost isn’t too bad, but the devices take a chunk out of the reimbursement for the ASC side of the business.

If you are trying to recruit some cardiac surgeons for this, their reimbursement, by bundling these procedures in a freestanding cath lab, can be well worth their time to discuss it with you.

Do your homework and see if this is for you. Depending on the case load of the heart docs, they may need as much as two days per week in the facility or as little as a morning or afternoon one day a week; then you can run the ASC as normal. It might be worth it to consolidate your schedule to consider this new revenue market.

Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: Web: