The rising number of cardiovascular procedures moving to non–hospital-based outpatient facilities, such as ambulatory surgery centers (ASCs) and office-based laboratories (OBLs), and its likely impact on quality, outcomes and access to care, is the topic of a Special Communication article published July 7 in JACC.

Throughout the article, Katerina Dangas, MD, et al., break down the driving factors of this shift like physician autonomy, technological advancement, same day discharge, lower costs, patient experience and policy changes, and discuss key considerations including market trends, case selection and practice patterns, quality and evidence, access to care and regulation. “As these trends unfold, creating mechanisms and policies to measure, incentivize, and optimize care quality, clinical outcomes, and patient care experience remains an elusive but critical goal,” state the authors.

They outline features that make up a high-quality ASC PCI program, discuss variability across practices, and lay out current data available to assess ASC safety and performance. Meanwhile, the potential positive effects that ASCs and OBLs may have on health care are also explored, with the authors writing “the evidence on whether ASCs and OBLs improve access to procedural care for socioeconomically disadvantages communities is mixed.”

Regulatory considerations are also described, highlighting how the Centers for Medicare and Medicaid Services and Certificate of Need laws contribute to “a complex regulatory landscape” governing the “establishment, operation, and scope of services at both the federal and state levels.”

Dangas and colleagues call for “a more coordinated approach to ensure that all procedural sites deliver safe, equitable, and high-quality care.” To evaluate the safety and effectiveness of cardiovascular procedures being performed in ASCs or OBLs, they suggest advancing “the collection of registry data that may serve as a backbone for evaluating key measures of care quality, access, and outcomes.”