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May 14, 2020

SCAI Provides Recommendations on Performing PCI in Ambulatory Surgical Centers

May 14, 2020—A position statement on the performance of percutaneous coronary intervention (PCI) in ambulatory surgical centers (ASCs) was issued by the Society for Cardiovascular Angiography and Interventions (SCAI). The document was presented at the society's 2020 Scientific Sessions Virtual Conference held May 14–16 and published by Lyndon C. Box, MD, et al online in Catheterization and Cardiovascular Interventions.

SCAI noted that in the Centers for Medicare & Medicaid Services recently began reimbursement for PCI performed in ASCs in response to data on patient outcomes from observational studies and randomized controlled trials supporting same-day discharge (SDD) after PCI.

Dr. Box, who is chair of the statement's writing group, commented in the SCAI press release, “One of the biggest stories in interventional cardiology this past year was the initiation of payment by Center for Medicare and Medicaid Services for PCI performed in ambulatory surgical centers (ASC). SCAI recognized the potential for this new rule to decrease cost, improve patient satisfaction, and increase physician autonomy.

“It is crucial that patients in the ASC receive the same quality of care as those in the hospital setting. The paper covers regulatory issues, standards, protocols, quality assurance, and ethics. This paper is a ‘must-read’ for anyone involved with PCI in an ASC.” Dr. Box is an interventional cardiologist at West Valley Cardiology Services in Caldwell, Idaho.

According to SCAI, the position statement makes recommendations for facility and equipment standards, procedural and periprocedural standards, transfer protocols, and operator standards based on an examination of the evidence for potential benefits and harms. The statement also provides an overview for operators on regulatory considerations.

As summarized by SCAI, the document advises the following:

  • Diagnostic procedures (ie, left and right heart catheterization, coronary and graft angiography) are appropriate in an ASC
  • Invasive diagnostic testing that involves intravascular imaging (ultrasound and/or optical coherence tomography) or functional evaluation (fractional flow reserve and/or resting indices) and coronary angioplasty and stenting are appropriate in an ASC
  • Only patients who are considered appropriate for SDD should be considered for intervention in an ASC
  • Not all patients who might be suitable for SDD in the hospital setting are appropriate for ASC-based PCI, because the ASC setting does not provide the option of easily converting a patient to overnight observation
  • PCI in patients with high-risk clinical features should be avoided in the ASC setting
  • The decision to perform PCI in an ASC should be made in the context of the local health care environment
  • Initiation of an ASC PCI program should require transparent adherence to state and federal regulations and operational standards

Guidance on patient suitability for SDD was provided in the 2018 SCAI Expert Consensus Document on Length of Stay Following PCI, which was published online in April 2018 by Arnold H. Seto, MD, et al in Catheterization and Cardiovascular Interventions, noted SCAI in the announcement.

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