The landscape of total joint replacement procedures is changing, and ASCs are increasingly looking to these procedures for growth.
Here’s 10 things to know about the state of total joint replacements:
- Total joint replacements are increasingly migrating to the outpatient setting. As of last year, the volume of orthopedic surgeries occurring in the outpatient setting was 33 times higher than those occurring in the inpatient setting. From 2019 to 2023, the number of knee replacements occurring in an outpatient setting increased 293%.
- More ASCs are offering total joint replacement procedures than ever before. More than 600 ASCs in the U.S are performing total joint replacements. Becker’s has an updated list here.
- Despite outpatient affordability, costs are still rising. While TJR is overall more affordable in outpatient settings, costs continue to rise. Total costs for knee arthroplasty, for example, jumped from $7,294 in 2018 to $9,240 in 2024.
- Total joint replacements are driving ASC growth. Earlier this year, physicians told Becker’s that total joint procedures were key to the future of ASC growth. "ASCs are demonstrating that quality care for total joints can be achieved while ensuring patient safety and satisfaction are at the forefront of their experience," Joyce White, RN and facility administrator of Cypress Surgery Center in Wichita, Kan., told Becker's.
- Outpatient TJR procedures are increasingly covered by CMS. Last year, the CMS added total shoulder replacement to its ASC-covered list.
- Overnight stays are still possible for TJR patients at some ASCs. Not all states allow overnight stays at ASCs, and not all ASCs that offer TJR have the ability to offer services overnight. However, some are exploring other options, including discharging patients to hotels near the facility for close monitoring or working with home health nurses to care for patients after they are discharged.
- Robotics are increasingly common for TJR surgeries. Robots have become increasingly standard for many high-acuity procedures as ASCs, including TJR. The use of robots in total knee arthroplasty increased sixfold between 2017 and 2023, according to the American Joint Replacement Registry’s 2023 report.
- Margins are better for hip and knee replacement in the outpatient setting than inpatient. In 2023, the average margin for outpatient hip replacements was $3,466, while the inpatient hip replacements averaged a $3,498 loss.
- Staffing is still an issue for the future growth of outpatient TJR procedures. While staffing is a struggle across healthcare, successful outpatient TJR procedures rely on well-trained physicians with experience in surgery center management. Steven Barnett, MD, CMO of the Hoag Orthopedic Institute of Irvine, Calif., told Beckers, “You need very competent management and leadership from the board of directors and staff to make it work.”
- Reimbursements are another challenge. Despite the technological advancements that have made ASCs a viable setting for TJR, reimbursement for these procedures still remains lower than those in the hospital setting. CMS’ finalized payment rule for ASCs in 2024 was 3.1%, a decrease from 3.8% in 2023.