How the Move of Ablation Procedures into Surgery Centers Will Transform Electrophysiology

Electrophysiology procedures take place in hospitals. That’s been the widely held assumption — until now. 

There’s plenty of reasons that people think EP procedures belong in hospitals. After all, in these procedures, the physician inserts sheaths, catheters, and needles into the patient’s heart and performs ablation therapy that addresses what is commonly known as “electronic misfirings” inside the heart. You certainly would want to be in a hospital when undergoing such an advanced and, seemingly, risky procedure, right? 

And yet, a big focus in EP right now — and among cardiologists in general — is the imminent migration of ablation procedures out of the hospital and into the surgery center. Why is this happening? And what can the healthcare industry expect as a result? 

Why EP procedures are migrating to surgery centers

Already EP-focused surgery centers have emerged where patients with private (commercial) insurance can receive ablation procedures. Most industry observers expect the Centers for Medicare & Medicaid Services (CMS) to issue reimbursement codes for certain ablation procedures under Medicare/Medicaid in 2026 — which is not that far away at all. This evolution would follow similar developments in other procedure areas, including orthopedics and ENT, where up to 90 percent or more of procedures are now performed outside of the hospital.

The movement of EP procedures into surgery centers says a lot about the safety of the space. When things go wrong in a procedure, you most certainly want to be in a hospital; the capability of a hospital to address major adverse events in a procedure is immensely higher than the capability of a surgery center to address the same. This is the reason most surgery centers are located close to a hospital, after all. 

Despite the gravity of any healthcare procedure that involves an organ as vital to life as the heart, EP ablation procedures are quite safe. Studies show that adverse events in EP ablation procedures occur far less frequently than in other procedures — including orthopedics, which has already moved to the surgery center setting. Within electrophysiology, cardiac perforation causing tamponade is the most common adverse event from EP ablation procedures. While it can be deadly, electrophysiologists can usually handle these emergently. 

But, even if the risk is minimal, why take a risk at all? Well, procedures done in the surgery center are much less expensive and are usually associated with high financial rewards for the electrophysiologists, who are often co-owners of the surgery center. Interestingly, one of the drivers behind the growth in surgery center ablation is the fact that CMS has reduced physician reimbursement significantly in recent years.

Surgery centers can do EP ablation procedures much less expensively because they are run more like businesses than hospitals. As large institutions with high degrees of complexity and administrative burdens, hospitals waste a lot of resources. In contrast, surgery centers are often run by business executives who know how to create efficiencies while also providing high quality care. I have actually heard several hospital executives admit that they “would like to learn how to do healthcare from the surgery centers.”

What to expect as EP procedures move into surgery centers

Within a matter of months, we’re going to see substantial growth in the number of EP ablation procedures performed in surgery centers outside the hospital. Here’s what we can expect. 

• Reimbursement: CMS will not issue reimbursement codes for all EP ablation procedures in 2026. Rather, it will likely issue reimbursement codes for ablation procedures that are less complex (i.e., less risky). This will correspond with the appetite of the electrophysiologists, who will also not want to do the most complex procedures on day one in the surgery center. The elderly atrial fibrillation patient with lots of co-morbidities will likely still be treated at the hospital. Similarly, many re-do procedures (most ablation procedures that are not successful on the first attempt) will probably also be done in the hospital. CMS will then gradually add codes as the migration proves to be successful.
• New approaches: We will see new approaches and methodologies to EP ablation emerge and evolve in the surgery center setting. This is because of the type of procedures initially moved into the surgery center; they are less difficult, likely faster, and require less technology. At the same time, the electrophysiologists in surgery centers are financially incentivized and will approach their methodologies with a different mindset than the hospital-reimbursed doctor. This will lead to interesting — and useful — new developments. The best manufacturers of ablation technology are watching some of these doctors carefully to see what will happen when ingenuity meets financial incentives.
• Innovation: It follows that we will see new technologies for EP ablation emerge and develop in the surgery center. In fact, some argue that already the launch of pulsed field ablation (PFA) technology in the EP space pre-empts the migration of EP ablation to the surgery center (and the different mindset and procedure conditions of this setting) with EP ablation technology that allows for faster and safer procedures.
• Efficiency: PFA-based ablation procedures will also allow for procedures that use fewer devices and have reduced complexity, thereby driving down costs. We will see new technologies that make it easier to either switch between brands or completely eliminate the need for devices — in both cases optimizing both clinical choice and efficiency. This is an interesting reversal of the situation in the hospital, where procedures are typically overloaded with devices to allow for multiple visual modalities and (arguably) excessive procedure steps. Much of this will be dropped in the surgery center. Mind you, this doesn’t mean you get a “lesser procedure.” It simply means that what was unnecessarily used and paid for is no longer included.
• Physician migration: Some of the best electrophysiologists in the country are going to be among the first to start doing procedures in the surgery center. They are physicians who are skilled enough in their practice to want to do procedures without excessive equipment, and who are confident enough in their practice to develop new perspectives and methodologies. These physicians will have a different mindset due to who they are, but also due to where they are. They will be performing simpler procedures in less time, using fewer devices. They will also be making more money, and their choice of methodology, approach, and technology will be impacted by the fact that they have financial interest in the profitability of the surgery center.
• Device re-use: Finally, we will see more device re-use: Single-use device reprocessing is already of key importance to the financial sustainability of hospital-based procedures. In the surgery center, the physician’s legacy preference for a brand-new device will be replaced by the financial appeal of reprocessed devices that can be acquired at half the price.

The fragmentation of care setting that we experience with the migration of procedures out of the hospital is a good thing. It makes healthcare less expensive, eliminates inefficiencies, and creates the kind of competition hospitals have never really had. It’s the kind of progress that physicians and patients alike have reason to celebrate.

Photo: hudiemm, Getty Images

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