News | Published: Tuesday, May 5, 2026
Cardiovascular ambulatory surgery centers (ASCs) may be one of the fastest-growing segments in outpatient care, but a general session at CV Transforum Spring’26 made clear they are also among the most difficult to launch successfully.
Sammy Ramirez, MBA, MSN, CEO of Banner Cardiovascular Center Arcadia, traced the evolution of ASCs, noting that while specialties like gastroenterology and orthopedics began shifting to outpatient settings in the 1970s and 1980s, cardiovascular care has been “very late to the ASC game.” The turning point came around 2018, when the Centers for Medicare & Medicaid Services (CMS) expanded its covered procedures list to include key cardiovascular interventions such as PCI. More recently, procedures like cardiac ablation have also gained reimbursement approval, accelerating momentum.
Today, the ASC model for cardiovascular care rests on three core pillars: efficiency, patient experience and cost savings. Physicians can achieve higher procedural volumes than in hospital settings, patients benefit from streamlined same-day care, and payers see reduced costs.
But as Ramirez emphasized, the gap between vision and reality is substantial.
“It’s significantly harder than it looks,” Ramirez said, summarizing the challenges of regulatory hurdles, staffing shortages, capital demands and operational unpredictability. Many new centers underestimate timelines, with two to three months – or more – typically added to projected opening dates.
Using the example of the Banner Cardiovascular Center Arcadia, launched in April 2025 through a joint venture (JV) between Banner Health and MedAtlas CV, Ramirez walked through the journey from concept to operations.
Success begins with early strategic decisions. Market analysis and case mix are critical, particularly in determining profitability. Electrophysiology (EP) procedures, for example, tend to generate higher margins, while diagnostic catheterizations and some PCI procedures offer lower reimbursement. Understanding the competitive landscape and aligning with hospital partners – who often serve as referral sources – is equally important.
Payer strategy can also be a long lead-time item. Securing contracts with major commercial insurers may take years, requiring organizations to start early.
From there, the conversation shifts to site selection and design, where efficiency and compliance intersect. Cardiologists need to remain on-site while patients recover, minimizing travel and maximizing throughput. At the same time, facilities must meet strict regulatory standards, including life safety codes, proper airflow for preoperative and procedural areas, and CMS requirements that ASCs function as distinct entities within buildings.
“Architects and engineers aren’t enough,” Ramirez noted. “You need clinical input in design.” Missteps such as inadequate storage, poor workflow layout or insufficient equipment planning can create long-term inefficiencies.
Capital investment is another major consideration, with construction and specialized equipment – such as C-arms, fluoroscopy systems, and crash carts – representing significant upfront costs. Facilities must also plan for ongoing requirements, including annual physicist inspections for imaging equipment and robust IT and electronic medical record integration.
The regulatory pathway remains one of the most challenging phases. Facilities must secure state licensure before pursuing Medicare certification, all while building compliance with federal Conditions for Coverage. Parallel processes – such as CMS enrollment, laboratory certification, radiation registration and payer contracting – must be carefully coordinated.
Staffing adds another layer of complexity. Cardiovascular ASCs require highly specialized teams, often necessitating “overbuilding” staffing models early to handle volume growth and avoid operational bottlenecks. At the same time, leaders must balance rising labor costs and maintain a strong organizational culture.
Clinical quality and physician alignment ultimately determine long-term success. Facilities must track key metrics such as complication rates, hospital transfer rates and registry data from day one. Just as importantly, physicians must be financially and operationally aligned.
“Volume commitments versus reality is a big issue,” Ramirez warned. “If your physicians aren’t financially aligned, your ASC won’t work.”
JVs emerged as a critical enabler in navigating these challenges. By combining hospital partnerships, physician engagement and operational expertise, JVs can provide brand credibility, streamline revenue cycle and contracting, and ensure clinical leadership.
Ramirez concluded, “A cardiovascular ASC isn’t just a facility. It’s a business, a clinical program and a regulatory machine all at once. When each partner focuses on what they do best, that’s when these centers succeed.”
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