The New York State Public Health and Health Planning Council (PHHPC) may consider a limited policy change at its Feb. 19 meeting. This change would allow certain ambulatory surgical centers (ASCs) affiliated with New York’s general hospitals to perform coronary interventions, provided they meet specific criteria. Additionally, PHHPC has indicated that it may consider expanding this policy to include other types of ASCs in the future.
PHHPC, a statutorily recognized public body in New York, oversees public health and health care delivery. PHHPC adopts and amends the operating regulations for health care facilities, home care agencies, and hospice programs. PHHPC approves new establishments and ownership transfers, reviews major projects and service changes, and advises the Commissioner of Health on strategies to improve public health.
If PHHPC approves this policy, the New York State Department of Health (DOH) would move forward with implementation.
Background and Regulatory Context
New York currently restricts percutaneous coronary interventions (PCIs) to Article 28 general hospitals. PCIs are widely considered a minimally invasive procedure used to open narrowed or blocked heart arteries.
State law specifically defines a “general hospital” as “a hospital engaged in providing medical or medical and surgical services primarily to in-patients by or under the supervision of a physician on a twenty-four hour basis with provisions for admission or treatment of persons in need of emergency care and with an organized medical staff and nursing service, including facilities providing services relating to particular diseases, injuries, conditions or deformities.”
Long-standing state regulations have confined PCIs to these general hospital settings to ensure institutional oversight and immediate access to higher-level care during complications. Currently, 78 general hospitals in New York perform approximately 52,000 PCIs annually—35 with on-site cardiac surgery and 43 without.
This approach differs from approximately 20 other states that allow PCIs in ambulatory settings. These ambulatory procedures show similar complication rates to general hospitals (about 1%) but cost roughly 40% less, generating savings of approximately $4,000 per procedure.
Development of PHHPC Recommendations
PHHPC crafted its recommendations after reviewing technical literature on PCI outcomes, consulting with the DOH’s Cardiac Services Program, and gathering input from hospital associations, cardiac care professionals, patient advocates, and regulators from states with established ASC-based cardiac programs.
Proposed Regulatory Framework: Phased Implementation
The proposal begins with restricted eligibility—only Article 28 general hospitals that fully own non-profit ASCs and maintain existing cardiac surgery programs would qualify initially. Additionally, these ASCs must use their parent general hospital’s quality review and data reporting systems.
Approval requires a time-limited Certificate of Need process, including a Health Equity Impact Assessment and guaranteed access for Medicaid and low-income patients. The state would collect data on clinical outcomes, social vulnerability, and access to future decisions, including potential expansion to independent ASCs not affiliated with general hospitals.
Regulatory Approach and Potential Effects
This initiative might potentially reduce per-procedure costs by up to 40% and expand access to cardiac services, particularly in underserved and rural areas, with future phases potentially addressing geographic and demographic gaps.
To maintain quality standards, the new structure establishes clinical criteria, staffing requirements, and emergency protocols developed with the DOH Cardiac Advisory Committee. This phased approach would allow New York to take a hybrid approach between states that broadly permit ASC-based cardiac procedures and those that restrict them entirely to general hospitals.
Legal and Administrative Considerations
Implementation would require extensive administrative rulemaking covering patient selection criteria, staffing requirements, facility standards, emergency protocols, and reporting mechanisms. These new regulations must align with existing frameworks governing facility licensure, scope-of-practice laws, and payment systems.
Conclusion
This proposed policy represents a significant, but limited, regulatory development in New York’s healthcare landscape by creating new pathways for cardiac intervention delivery. Integrated data collection and evaluation will inform policy adjustments during both implementation and potential expansion phases.
Currently, this policy would apply only to ASCs operated by existing New York State general hospitals. In the next phase, PHHPC and DOH may consider expanding eligibility to independent and for-profit ASCs, which would introduce additional legal considerations related to facility ownership and regulatory oversight.