Outpatient total joint replacement volumes are expected to increase 104 percent in the next five years while inpatient volumes will likely decrease, according to The Advisory Board 2017 Orthopedics and Spine Market Trends report.
Here are the responses to four key questions about total joints in ASCs. If you would like to learn more about launching a total joint replacement program at your ASC, join an upcoming free webinar on May 22, 2018, at 1 p.m. CST. Click here to learn more and register.
Q: Will CMS reimburse for total knee replacements in ASCs?
No — CMS removed total knee replacements from the "inpatient only" list but did not place them on the "ASC payable" list. The removal from the inpatient only list doesn't require the procedure to go outpatient, but allows for the possibility in the future.
Q: Would CMS allowing total joints in the ASC be good or bad for ASCs?
It depends on the rates set for the procedure. CMS typically reimburses less than private payers, and private payers often set rates based on a percentage of Medicare. ASCs are currently negotiating rates with private payers without that baseline, so if and when CMS sets a rate for total knee replacements, it could push private payer rates lower as well. However, it would allow for additional cases in the ASC among appropriately selected Medicare patients.
Q: How can I decide whether it would make sense for me to take cases to the outpatient setting?
There are many factors that go into transitioning total knee and hip replacements from the inpatient to outpatient setting; it requires minimally invasive techniques, advanced pain management and anesthesia and the right preop and postop team in place to ensure patients recover appropriately. Patient selection is also important to avoid complications, transfers, readmissions and bad outcomes. The patients should undergo preoperative education about procedure and discharge expectations.
Q: My partners and I are ready to develop a program for our ASC. Where do we begin?
It takes significant planning to bring total joints into the outpatient setting; make sure you have the right infrastructure in place and staff is prepared for these procedures. Total joint replacements are often longer procedures and patients need longer recovery than other outpatient orthopedic surgeries, so workflow within the center will change. You will also need to bring anesthesiologists on board, negotiate insurance and implant contracts and consider procedure volumes before deciding whether outpatient total joints are a good fit for your ASC.
Learn more about the best practices and tips for success in this upcoming free webinar on May 22, 2018, at 1 p.m. CST. Register here.
Additional resources on outpatient total joint replacements:
2018 Total Knee Arthroplasty FAQs (AAOS)
Total joints in ASCs (Becker's ASC Review)