With ambulatory surgical centers (ASCs) continuing to emerge as alternatives to hospital-based care, “appropriately selected procedures in the field of cardiac electrophysiology … could increasingly shift to an ASC setting,” according to a new Heart Rhythm Society (HRS)/ACC Scientific Statement providing “Guiding Principles on the Performance of Intracardiac Ablation Procedures in [ASCs].” The document outlines key considerations for managing this evolution and sustaining a culture of quality.

Led by Writing Committee Co-Chairs Amit Jay Shanker, MD, and Samuel O. Jones IV, MD, MPH, FACC, the statement examines current data and real-world factors influencing intracardiac ablation procedures in ASCs, including staffing trends and patient access, particularly in underserved and rural areas.

“Although the expansion of ASCs may offer significant benefits, potential adverse consequences for health care access must be carefully weighed,” the authors write. “A sustained shift in procedural volumes from hospitals to ASCs might precipitate economic and workforce challenges for these institutions, particularly in regions reliant on hospital-based care.”

The statement also explores payer policy and barriers to implementation, such as certificate of need programs in various states, private equity growth, vertical integration and market dynamics. With anticipated changes in reimbursement and regulation, it emphasizes strategies to address regional differences in ASC oversight, value-based payment models and integration of supporting procedures.

“Medical professional societies can collaborate with payers and other stakeholders to provide guidance and track clinical outcomes and cost-effectiveness in the ASC setting through registries and other measures,” state the authors.

Looking ahead, the statement provides guidance on sustaining equity and quality while managing ethical and financial risks. Best practices for facilities, physicians and staff are framed around shared decision-making focused on patient safety, access, informed consent and well-being. Optimal patient selection is also highlighted as critical to ASC program safety. The document outlines patient, procedure, operator and facility factors linked to unfavorable, less favorable and most favorable outcomes. It also details principles for risk management, discharge planning and emergency transfer protocols.

“Performance of intracardiac ablation procedures in the ASC setting will require collaboration among stakeholders (clinicians, policymakers, payers, and advocacy groups) to investigate and ensure safety and effectiveness, harmonize payment policies, prioritize equitable access and embed rigorous quality assurance frameworks,” write the authors. “By integrating data-driven protocols, clinical excellence, and ethical practices, ASCs could fulfill a defined adjunctive role in a value-based health care system, assuring high-quality care without compromising patient safety while improving access.”