The Right Care, in the Right Setting: Rethinking Site of Service in Cardiology

For decades, the hospital has been the default setting for many cardiovascular services. But as technology advances, care models evolve, and healthcare continues its shift toward value, a growing range of diagnostic and procedural services can now be delivered safely and effectively in outpatient settings for appropriately selected patients.

That shift is already underway. Cardiovascular procedures are increasingly moving into ambulatory surgery centers (ASCs), office-based labs (OBLs), and other outpatient settings, driven by:

• Advances in technology, anesthesia, and same-day discharge capabilities
• A more convenient and streamlined patient experience
• Greater physician involvement in care delivery
• The opportunity to reduce total cost of care
• In many cases, lower out-of-pocket costs for patients

The opportunity, however, is not simply to move care out of the hospital.

It is to ensure that every patient receives the right care, in the right setting, at the right time.

Why Site of Service Matters in Value-Based Cardiology

Where care is delivered can materially affect the patient experience, care coordination, clinical outcomes, and the total cost of an episode of care.

Hospitals remain essential for complex procedures, high-risk patients, emergency care, and cases requiring intensive clinical resources. But for appropriate patients and services, a lower-acuity outpatient setting may offer a more efficient and patient-friendly experience without the infrastructure, delays, and complexity often associated with a hospital environment.

This creates a meaningful opportunity within value-based cardiology.

When clinical needs and site of service are thoughtfully aligned, health systems and cardiovascular practices can work toward:

• Improving access, convenience, and timeliness of care
• Reducing unnecessary healthcare spending
• Lowering patient cost-sharing in many cases
• Creating more efficient care pathways
• Increasing physician involvement across the care continuum
• Reserving hospital capacity for patients who truly need it
• Improving the overall patient experience

Site of service is therefore more than an operational decision. It is a core component of managing cardiovascular populations effectively, responsibly, and sustainably.

Cardiovascular Care Is Already Moving Outpatient

The outpatient cardiovascular landscape continues to expand. The number of single-specialty cardiology ASCs in the United States quadrupled between 2018 and 2023, growing from 55 to 221.⁵

Depending on facility capabilities, patient factors, and regulatory requirements, non-hospital settings now support services ranging from diagnostic cardiac catheterization to select percutaneous coronary interventions (PCI), pacemaker procedures, and defibrillator procedures.¹ The American College of Cardiology has developed its CV ASC Registry Suite specifically to measure outcomes and support quality improvement across ASCs, OBLs, and outpatient surgery centers performing these types of cardiovascular procedures.²

Policy is evolving as well. For 2026, CMS expanded the number of procedures eligible for Medicare payment in ambulatory surgical centers and increased physician flexibility in determining the clinically appropriate setting for certain services.³ Cardiac catheter ablation procedures were added to the ASC Covered Procedures List for the first time, and CMS announced plans to phase out the inpatient-only list over the next three years.⁴

These changes reflect a broader evolution in cardiovascular medicine: for appropriately selected patients, the hospital is no longer the only setting capable of delivering high-quality specialty care.

Clinical Appropriateness Must Come First

Lower cost should never be the sole reason to shift a service to an outpatient setting.

A successful site-of-service strategy begins with appropriate patient selection and sound clinical judgment. Clinical complexity, comorbidities, procedural risk, anesthesia requirements, emergency-transfer capabilities, facility resources, and post-procedure needs must all be considered before determining where care should occur.

As cardiovascular procedures continue migrating into outpatient environments, the ACC has emphasized the importance of quality measurement, patient selection, safety standards, regulatory oversight, and consistent outcome tracking across sites of care.¹

The goal is not hospital versus outpatient.

The goal is to build a connected cardiovascular ecosystem in which each setting is used appropriately—and patients receive the level of care their clinical needs require.

The Value Across Stakeholders

For Patients

For appropriate services, outpatient care can offer a simpler and more convenient experience, including less time navigating large hospital campuses, more streamlined scheduling, and a potentially smoother recovery process.

It can also reduce the financial burden of care. Because ASCs and other outpatient facilities may have lower facility charges than hospital outpatient departments, patients may face lower copays, coinsurance, or other out-of-pocket expenses for the same or similar service.

Keeping care closer to a patient’s existing cardiovascular team can also strengthen continuity across diagnosis, procedure, follow-up, and long-term disease management.

For Providers

Outpatient capabilities can give cardiovascular practices greater flexibility in how care is delivered while keeping physicians closely connected to the full patient journey.

For independent practices in particular, thoughtfully designed outpatient strategies may help preserve clinical autonomy while creating more efficient pathways for diagnostics, procedures, recovery, and follow-up care.

For Payers and Health Systems

In a value-based environment, every part of the care continuum matters.

Avoidable utilization, fragmented referrals, duplicated services, and unnecessarily high-cost sites of care can all affect total cost of care.

Aligning appropriate services with the most efficient clinically appropriate setting creates an opportunity to improve the value equation without compromising quality.

For health systems, this also means using hospital resources where they are most needed: for complex, high-acuity, and resource-intensive care, freeing up capacity to do so.

Health system employed cardiology groups can also benefit from the incremental revenue opportunities with value-based care as well and CCA has programs for this.

Quality Has to Follow the Patient

As care expands beyond hospital walls, measurement and accountability must expand with it.

A high-performing outpatient strategy requires the same commitment to quality expected anywhere else in the cardiovascular continuum:

• Standardized clinical pathways
• Appropriate patient selection
• Transparent outcomes reporting
• Clear emergency-transfer protocols
• Reliable follow-up processes
• Continuous performance improvement

National efforts are already moving in this direction. The ACC’s cardiovascular outpatient registry enables participating facilities to benchmark outcomes, monitor adverse events and hospital transfers, and compare performance across similar facilities.²

That infrastructure will become increasingly important as more cardiovascular care moves into new settings.

The Bottom Line

Value-based cardiology asks a different question than traditional fee-for-service medicine.

Not simply, “What service does this patient need?”

But also, “Where can that service be delivered safely, effectively, conveniently, and efficiently?”

Hospitals will always play a critical role in cardiovascular medicine. But they do not need to be the default location for every test, procedure, or episode of care.

By matching clinical needs with the appropriate setting, cardiovascular organizations can improve access, enhance the patient experience, reduce avoidable financial burden for patients, use healthcare resources more efficiently, and lower total cost of care.

Where CCA Comes In

At Cardiac Care Alliance (CCA), we believe the future of cardiovascular care is built around connected, physician-led care pathways that put clinical decision-making first.

Our value-based approach helps cardiology practices look across the full continuum of care—from prevention and chronic disease management to diagnostics, procedures, and ongoing monitoring—to identify opportunities for better coordination, stronger outcomes, and more efficient care delivery.

As outpatient cardiovascular capabilities continue to expand, CCA is focused on helping provider partners evaluate how the right infrastructure, data, care pathways, and site-of-service strategies can support better outcomes while preserving physician autonomy.

Because better value does not come from simply delivering less care. It comes from delivering the right care, in the right setting, at the right time.

To learn more about Cardiac Care Alliance and our physician-led approach to value-based cardiology, contact us at network@cardiaccarealliance.com.

Sources

1. American College of Cardiology. CV Procedures Shifting Into Outpatient Facilities: Key Considerations. July 15, 2025.
2. American College of Cardiology, NCDR. CV ASC Registry Suite: Designed for the Growing Shift to Outpatient Cardiovascular Care.
3. Centers for Medicare & Medicaid Services. Calendar Year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule. November 21, 2025.
4. American College of Cardiology. CMS Releases 2026 Hospital OPPS Final Rule. November 21, 2025.
5. Journal of the American College of Cardiology. Outpatient Migration of Cardiovascular Procedures in the United States. July 2025.