10 things to know about total joint replacement in ASCs for 2019

Total joint replacements in ASCs are increasing in popularity and becoming more common. The shift to value-based care, insurance coverage expansion and studies showing good patient outcomes in the outpatient setting are just some of the trends driving total joints to the outpatient setting.

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Ten key details to know about total joint replacement in ASCs:

1. Over 250 ASCs offer total joint replacements in the U.S. You can find a list of the number of ASCs per state here.

2. More ASCs are taking on total joint replacement cases. Humana and Towson, Md.-based SurgCenter Development entered an agreement adding more than 100 SurgCenter Development locations to Humana's national provider network. The agreement expands Humana members' access to total knee, hip and shoulder replacements in an ASC setting.

3. Total joint surgery is more affordable in an ASC. A new study suggests there isn't increased risk for patients undergoing outpatient joint replacements performed in the ASC setting when compared with the inpatient hospital setting, according to new research from New York City-based Hospital for Special Surgery and Philadelphia-based Rothman Orthopaedic Institute. The surgery cost for the ASC group was 40 percent less than the hospital group detailed in the study. On average, outpatient surgery cost $11,677, with inpatient surgery costing $19,361.

4. Becker's ASC Review reported 13 ASCs added total joint replacement cases in the past year. Here are a few noteworthy examples:

Last November, Jared Roberts, MD, performed the first total hip replacement at Albany, N.Y.-based Capital Region Ambulatory Surgery Center.

Canton, Ohio-based Omni Orthopaedics aims to open a new ASC in Jackson Township, Ohio, later this year that will include total joint replacement alongside sports medicine and general orthopedics.

On Feb. 11, physicians at Northwell Health's Manhasset, N.Y.-based Schwartz Ambulatory Center performed its first total hip replacement procedure. The ASC began offering total shoulder replacements last year, and Northwell plans to add total knee, hip and shoulder surgeries at other ASCs across its network.

5. ASCs with an outpatient total joint replacement program often have the ability to keep patients overnight. Not all states allow surgery centers the option for overnight stays. ASCs are exploring other options as well, including discharging patients to hotels near the center for close monitoring or working with home health nurses to visit the patients after they're discharged home.

6. Van Nuys-based Southern California Orthopedic Institute CNO Rashel Campos, RN, BSN, spoke to Becker's ASC Review about how using Global 1's bundled payments structure helped the organization move total joint and spine procedures to its outpatient centers. The important elements of a successful bundled payment program include good communication between physicians, the scheduling physicians' office and the surgery center.

7. Thomas V. King, MD, an orthopedic surgeon who practices at the Knee Hip and Shoulder Center at Portsmouth (N.H.) Regional Hospital, developed a program for patients undergoing outpatient joint replacement in collaboration with Kathleen Leavitt, PA-C. After refining the program for several years, Dr. King allows up to 70 percent of patients to go home within hours of their surgery.

8. Blue Cross Blue Shield Association released a report outlining trends in planned hip and knee replacement surgeries, which are increasing in the U.S. The states that reported the most outpatient knee and hip replacement surgeries were performed in Colorado, Minnesota, Mississippi and Alaska.

9. In 2017, 15 percent of total joint replacements were performed outpatient. Here are the projections over the next eight years, according to Sg2:

• 2020: 32 percent outpatient
• 2022: 37 percent outpatient
• 2024: 43 percent outpatient
• 2026: 51 percent outpatient

10. CMS paved the way for price transparency between ASCs and hospital outpatient departments with a new tool that reveals the average payments for select procedures in both settings.The Procedure Price Lookup tool includes the national average payments to HOPDs and ASCs, as well as the average copay Medicare beneficiaries without supplemental insurance would pay in both settings.Several orthopedic procedures are also listed in the database. For example, Medicare pays $1,024 for a knee arthroscopy with meniscus repair in an ASC, compared to $2,116 in an HOPD. Medicare beneficiaries without supplemental insurance have a copay of $256 in ASCs and $529 in HOPDs.

More articles on orthopedics and TJR:
The Orthopaedic Surgery Center signs contract with ORHub
CHI Franciscan Health settles lawsuit alleging 2 physician group deals were illegal — 6 details
Hospital for Special Surgery study reevaluates precautions for total hip arthroplasty: 3 study details

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