14 things to know about total joint replacements and ASCs for 2020

The volume of total joint replacements in ASCs is increasing. 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 outpatient.

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

1. Over 300 ASCs offer total joint replacements in the U.S. You can find a list of the number of ASCs per state here.

2. Total joint surgery is more affordable in an ASC. A 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.

3. Becker's ASC Review reported 12 ASCs added total joint replacement cases in 2019. Here are a few noteworthy examples:

- Steindler Orthopedic Clinic is now offering total knee replacements at Iowa City (Iowa) Ambulatory Surgical Center through its Joint Center of Excellence program.

- San Rafael, Calif.-based Marin Specialty Surgery Center moved to a larger location in 2019 to accommodate outpatient total joint procedures.

4. ASCs with an outpatient total joint replacement program in some states have the ability to keep patients overnight. 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.

5. At least seven ASCs acquired surgical robots for joint replacement in 2019. Read more about them here.

6. CMS included a site-neutral payment policy and added total knee replacement to the ASC-payable list in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule, which was released on Nov. 1, 2019. Total knee replacement became eligible for Medicare payment in the ASC setting in 2020. Knee mosaicplasty, six coronary intervention procedures and 12 procedures with new CPT codes were added to the ASC-payable list.

7. 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.

8. 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

9. 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.

10. Artificial intelligence may be used to aid in clinical decision-making following total joint replacement surgeries, according to a study from the New York City-based Hospital for Special Surgery. The researchers reported machine learning can improve clinical decision-making by helping physicians prioritize aspects of a patient's care following surgery based on predicted outcomes. Read the full story here. 

11. A bundled payment program can lower 90-day episode of care costs for Medicare patients undergoing total hip and knee arthroplasty, according to research published in the Journal of Arthroplasty. The bundled payment group had reduced hospital costs ($21,251 vs. $18,783), post-acute care costs ($13,488 vs. $12,439) and overall 90-day episode of care costs ($39,733 vs. $34,305). Read more here.

12. In 2019, Humana and Towson, Md.-based SurgCenter Development entered into 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.

13. About half of orthopedic surgeons in the U.S. have a subspecialty, according to Definitive Healthcare. Common orthopedic surgeon subspecialties include joint replacement, hand surgery and sports medicine. The number of knee replacements performed has increased 300 percent since 2005 and is projected to reach over 200,000 procedures by 2030, increasing the demand for orthopedic surgeons.

14. Partial knee replacement procedures are among the many services shifting from hospital settings to freestanding ASCs, according to an Advisory Board report. Partial knee replacement costs over $3,000 less in ASCs than hospital outpatient departments.

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