WHAT IS THE FUTURE OF VALUE-BASED CARE?

Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.

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Research

PCI is now eligible for freestanding care—will it shift in your market?

We recently published a site-of-care shift library compendium showing how procedures are set to shift out of the inpatient setting across the next few years. To project each procedure, we accounted for recent regulatory changes and market forces, such as the removal of a procedure from CMS’ Inpatient Only List (IPO) or the degree of specialist ownership in freestanding sites.

Because our methodology relied on projecting forward historical trends or using an in-service line parallel to project future shift, we didn’t include a projection for percutaneous coronary interventions (PCI). But with PCI newly on the Ambulatory Surgery Center (ASC) payable list, we do see potential for shift.

However this shift will only happen quickly if market forces pull eligible volumes out of the hospital.

Types of market forces to look for in the PCI market
Table: Types of market forces to look for in the PCI market

 

Based on these market forces, here’s how we think PCI could shift in your market.

  • 1. Lack of local market forces keeps PCI in the hospital
  • 2. Local market forces pull PCI out of the inpatient hospital

In reality, most markets will fall in-between these two extremes. If your market has many of the market conditions we described—but not all of them—then you should still expect some movement from PCI in the near future. But that movement will be slower than the rapid shift we’ve observed in the orthopedics service line. If your market has only a couple of these market conditions then PCI may still move to the freestanding setting at the expense of the inpatient hospital but shift speed is likely to be slow.

 


Footnotes

1 2024 ASC and IP market share is based on how market share grew for SI joint in the years following addition of the procedure to the ASC payable list. The remaining 2024 market share is attributed to the HOPD care setting. A longitudinal trendline is used to derive values between 2019 and 2024 for graphing purposes.

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