Current Developments in Outpatient Healthcare: Previous Obstacles and New Opportunities
The landscape of peripheral vascular services is undergoing a significant transformation, with a notable migration of procedures from hospital settings to freestanding facilities. This shift, which has been observed since 2008, is primarily driven by technological innovation, changes in the regulatory and policy environment, payer and purchaser preferences, and provider preferences.
The hospital of the future will offer a smaller array of complex services due to the decline in surgical volumes for PVI and the outmigration of endovascular PVI from the HOPD to the OBL. This transition has disrupted the ambulatory space for endovascular lower extremity interventions for some time. However, the demand for peripheral vascular ambulatory services remains strong, with a 12% growth in HOPD and ambulatory vascular procedures forecasted over the next five years.
The privately-owned and operated freestanding facilities offer providers opportunities for upside financial gain and greater freedom in their day-to-day practice. This shift is not without its challenges, as facilities must offset declining reimbursement by increasing procedural volumes or improving operational efficiency, which may come at the expense of provider experience.
The decline in reimbursement for vascular procedures performed in the ASC and OBL is likely to continue, with MA strategies for cost control focusing more on downside incentives such as prior authorization, narrow networks, new price transparency tools, or claims denials of hospital services.
Key drivers of this shift include the rising prevalence of peripheral arterial disease (PAD) and cardiovascular diseases, the shift towards minimally invasive outpatient procedures, expansion of ambulatory facilities and procedural volume, technological advancements, policy and reimbursement incentives, and cost-effectiveness and patient experience.
The global burden of PAD is increasing, especially in aging and diabetic populations, with over 230 million people affected worldwide. The market for intravascular lithotripsy, a minimally invasive technique effective for treating calcified arterial lesions, is expected to grow at a CAGR of 15.3% from 2025 to 2032. The number of single-specialty cardiology ASCs has increased significantly, and about 65% of outpatient peripheral vascular interventions in Medicare beneficiaries now occur in OBLs.
Innovations in technology, including smaller and more compliant vascular grafts, 3D cell printing, cell-free grafts, and advanced imaging/catheter technologies, are improving procedural safety and outcomes, further boosting adoption in outpatient settings. Medicare and CMS have expanded procedural coverage and adjusted reimbursement to favor outpatient care, supporting the migration of cardiovascular and peripheral interventions to ASCs and OBLs.
Outpatient interventions reduce hospital stays and risk of hospital-acquired infections, enabling same-day discharge and better patient satisfaction. As such, this trend is likely to continue, contributing to faster patient recovery, reduced costs, and improved patient experience.
However, it is essential to integrate the growing ambulatory footprint with what remains of the hospital enterprise to ensure that the future of ambulatory services is one of coordinated delivery, rather than chaos. CMS is now working to reduce reimbursement for PVI outside of the hospital, in an effort to control costs and reduce incentives for overutilization. The high CMS reimbursement that has been the norm in the past has already led to a proliferation of facilities in certain markets, lowering the potential market share (and thus profitability) for new entrants.
In conclusion, the future growth trends for ambulatory peripheral vascular services, particularly endovascular lower extremity interventions, indicate strong expansion driven by demographic shifts, technological innovation, healthcare delivery reforms, and evolving patient and provider preferences. This shift towards ambulatory services is not only beneficial for patients but also for the healthcare system as a whole, as it promotes cost-effectiveness, improves patient outcomes, and enhances the quality of care delivered.
- The changing landscape of peripheral vascular services is influenced by technological innovation, government policies, and provider preferences, which have led to the shift of procedures from hospitals to freestanding facilities.
- The decline in surgical volumes for PVI and the outmigration of endovascular PVI from hospitals to outpatient facilities have disrupted the ambulatory space for endovascular lower extremity interventions.
- Privately-owned and operated freestanding facilities offer providers financial gains and autonomy in their practice, but they must address challenges like declining reimbursement and ensuring quality care.
- The rise in peripheral arterial disease (PAD) and cardiovascular diseases, the shift towards minimally invasive outpatient procedures, and technological advancements are major drivers for the growth of ambulatory vascular services.
- Innovations in technology, such as smaller vascular grafts, 3D cell printing, and advanced imaging/catheter technologies, improve procedural safety and outcomes, making outpatient care increasingly popular.
- Outpatient interventions reduce hospital stays, lower the risk of hospital-acquired infections, and enable same-day discharge, leading to faster patient recovery and improved patient satisfaction.
- To ensure a coordinated delivery of ambulatory services in the future, it is crucial to integrate the growing ambulatory footprint with hospital infrastructure, avoiding chaos and maintaining high-quality care.
