Removing total knee arthroplasty from Medicare's inpatient-only list rapidly accelerated the shift to outpatient settings, according to a study published in AJMC.
Researchers conducted a retrospective analysis of Florida hospital discharge records from 2012-18. They tracked inpatient and outpatient performance of total knee arthroplasty cases at the state and hospital level.
After CMS removed TKA from the inpatient-only list Jan. 1, 2018, about 15 percent of Medicare TKA cases were shifted to the outpatient setting. TKA volume nearly doubled in the hospital outpatient setting among privately insured individuals under 60 years old. There was ample evidence that centers avoided migrating potentially high-risk patients to outpatient settings. Also, hospitals didn't shift procedures as aggressively.
Researchers concluded: "Market and financial pressures are encouraging more outpatient care delivery; however, the speed of transition is dictated, in part, by regulatory constraints. Our results suggest that Medicare policy may influence surgical treatment approaches for Medicare and privately insured patients. Spillover implications need to be considered when weighing future Medicare regulatory decisions."