HB 2545
In CommitteeHouse
Coronary interventions
Concerning patient access to elective percutaneous coronary interventions in ambulatory surgical facilities.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill requires the Washington State Department of Health to create new rules allowing elective percutaneous coronary interventions (a common heart procedure) to be performed at ambulatory surgical facilities (outpatient centers) by July 1, 2027, and to continue allowing them at certain hospitals without on-site cardiac surgery. It also requires an independent review of safety, access, and quality before rules are written.
- Requires the Washington State Department of Health to adopt rules allowing elective percutaneous coronary interventions (a type of heart procedure) at ambulatory surgical facilities (outpatient surgery centers) by July 1, 2027.
- Requires the Department of Health to adopt rules for performing these procedures at hospitals that do *not* offer on-site cardiac surgery (by an earlier deadline of July 1, 2008, though this deadline has already passed).
- Mandates an independent, evidence-based review—completed before rulemaking begins—on whether and how these procedures should be allowed in Washington, focusing on access, safety, quality, cost, and impact on existing cardiac care providers.
- Requires the Department of Health to consider the review’s findings and recommendations when writing the rules.
- Includes a specific requirement to maintain elective coronary intervention volumes at the University of Washington at levels needed to support cardiologist training, per national accreditation standards.
Who is affected
- Patients needing heart procedures — Patients in Washington who need elective percutaneous coronary interventions (a common heart procedure to open blocked arteries) may gain access to the procedure at more locations, including outpatient surgery centers, if new rules allow it.
- Ambulatory surgical facilities — Ambulatory surgical facilities (outpatient centers) that want to offer this procedure would need to meet new state safety and quality standards before doing so.
- Hospitals without on-site cardiac surgery — Hospitals that currently perform this procedure without on-site cardiac surgery may need to meet stricter state requirements to continue offering it.
- Cardiology training programs — Cardiology training programs, especially at the University of Washington, may be affected if volume requirements for training are adjusted as part of new rules.
Pro/Con Analysis
Potential Benefits (5)
Allowing elective PCIs at ambulatory surgical facilities could significantly improve access for patients in areas without nearby hospitals offering PCI—reducing travel time, enabling earlier intervention, and increasing convenience, especially for elderly or mobility-limited patients. Evidence from other states shows comparable safety and patient satisfaction in high-volume ASFs.
HealthcarePeopleRef: Sec. 1(1)(b), RCW 70.38.128(1)(b)The requirement for an independent, evidence-based review—covering access, safety, quality, cost, and system stability—ensures that rulemaking is grounded in data rather than institutional lobbying, potentially leading to more balanced and patient-centered outcomes.
HealthcarePeopleRef: Sec. 1(2), RCW 70.38.128(2)Expanding PCI to ASFs may reduce overall system costs by shifting lower-risk cases from hospitals to outpatient settings, where overhead and facility fees are typically lower—potentially lowering premiums and out-of-pocket costs for patients and insurers.
HealthcarePeopleRef: Sec. 1(1)(b), RCW 70.38.128(1)(b)Mandating volume maintenance at UW supports cardiologist training continuity, helping preserve a critical pipeline of cardiac specialists in Washington—though this benefit is concentrated at one institution and may not translate to broader workforce distribution.
HealthcareLean peopleRef: Sec. 1(2), RCW 70.38.128(2)New PCI-capable ASFs may create jobs in interventional cardiology, nursing, and ancillary services—though many of these positions may require highly specialized (and higher-paid) staff, limiting broad employment gains.
Business & EmploymentLean peopleRef: Sec. 1(1)(b), RCW 70.38.128(1)(b)
Potential Concerns (5)
Expanding elective percutaneous coronary interventions (PCIs) to ambulatory surgical facilities (ASFs) introduces procedural risk to settings lacking immediate cardiac surgery backup—potentially increasing risk of catastrophic complications if a patient deteriorates during or after the procedure. While the bill mandates an independent safety review, it does not require ASFs to meet higher staffing, equipment, or transfer protocols, leaving patient safety dependent on facility-specific capabilities rather than enforceable state standards.
Public SafetyPeopleRef: Sec. 1(1)(b), RCW 70.38.128(1)(b)The independent review is required *before* rulemaking but is not binding—meaning the Department of Health may adopt rules inconsistent with the review’s findings, especially if political or institutional pressure arises. This creates uncertainty about whether safety and quality concerns identified in the review will actually shape final rules, weakening accountability.
HealthcarePeopleRef: Sec. 1(2), RCW 70.38.128(2)The requirement to maintain University of Washington (UW) PCI volumes for cardiologist training may inadvertently limit expansion of PCI access elsewhere, as new rules could prioritize volume preservation over equitable geographic or demographic access—potentially concentrating high-risk procedures at one academic center and reducing options for rural or underserved patients.
HealthcarePeopleRef: Sec. 1(2), RCW 70.38.128(2)Hospitals without on-site cardiac surgery that currently perform elective PCIs may face increased compliance costs or be forced to cease offering the procedure if new rules impose stricter infrastructure, staffing, or transfer agreements—potentially reducing local access in communities that rely on these hospitals, especially in rural or suburban areas with limited alternatives.
HealthcareLean peopleRef: Sec. 1(1)(a), RCW 70.38.128(1)(a)Ambulatory surgical facilities seeking to offer PCIs will need to invest in new equipment, staff training, and potentially emergency transfer agreements—costs that may be prohibitive for small or independent ASFs, potentially consolidating PCI services into larger, corporate-owned centers and reducing local competition.
Business & EmploymentLean peopleRef: Sec. 1(1)(b), RCW 70.38.128(1)(b)
Who Is Most Affected
Patients in rural or suburban areas without nearby PCI-capable hospitals stand to gain significantly from increased access—shorter travel times, earlier care, and potentially lower out-of-pocket costs. However, those in areas with existing hospital-based PCI may see little change, and high-risk patients could face increased safety concerns if transferred to ASFs without adequate backup.
Large, corporate-owned ASFs with existing cardiology partnerships and financial resources are best positioned to adopt PCI services—potentially gaining market share. Smaller, independent ASFs may struggle with the capital and operational burden, risking consolidation or exit from the market.
Hospitals without on-site cardiac surgery that currently perform PCIs may face increased regulatory burden or be forced to stop offering the service if they cannot meet new criteria—potentially reducing local access. Those that do comply may see volume shifts as patients opt for newer ASF locations.
University of Washington benefits from guaranteed PCI volume for training, supporting its academic mission. However, this may come at the expense of broader system flexibility—e.g., limiting growth at other centers or delaying adoption of new models like mobile or hub-spoke networks.
Insurance companies and large employers may benefit from lower facility costs associated with ASF-based PCIs, potentially reducing premiums. However, if complications increase due to suboptimal ASF capabilities, system-wide costs could rise due to readmissions or litigation.