15 things to know about total joint replacements and ASCs | 2021

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More total joint replacements are migrating to the outpatient and ASC setting following CMS payment updates and more studies showing the procedure can be performed safely in the outpatient setting.

Here are 15 things to know about the procedures and ASCs.

1. More than 500 ASCs offer total joint replacements in the U.S. A list of the number of ASCs per state is here.

2. California has the most ASCs performing total joint replacements, with 50 centers. Florida is No. 2, with 42 centers that have ASCs, followed by Maryland and Texas which each have 32 centers with performing total joint replacements.

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

4. During the COVID-19 pandemic, many states placed limits on performing elective procedures to support clinicians treating patients with the virus. When states allowed ASCs to resume elective procedures, more surgeons became interested in performing total joint surgeries in ASCs because the facilities didn't treat COVID-19 patients. The pandemic in some cases accelerated the shift from the inpatient to the outpatient setting.

5. 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.

6. Patients were willing to pay $3,152 more on average for physicians with higher star ratings, according to a January article in Health Affairs. The study authors surveyed 200 consecutive new patients with hip and knee pain about how CMS star ratings affected how much they'd be willing to pay for surgery. "Patients appear more willing to accept significantly higher copayments for higher quality of care, and surgeon quality seems relatively more important than hospital quality," concluded study authors.

7. Total knee replacement became eligible for Medicare payment in the ASC setting in 2020, and Medicare added total hip replacements in 2021. 

8. Moving half of routine total joint replacements from the hospital to ASC setting could yield $3 billion in annual savings, including $2 billion for privately insured individuals and employers as well as $1 billion for Medicare beneficiaries and the federal government, according to a report from UnitedHealth Group.

9. UnitedHealth Group's study of more than 1.2 million hip and knee replacement surgeries found 90 percent of procedures for privately insured patients were performed in hospitals. However, surgical site infections were present in 2.5 percent of those patients and resulted in 26,000 patients having longer hospital stays and requiring additional treatment. Moving half of routine inpatient joint replacements could result in 500,000 fewer hospitalizations, according to the report.

10. Sg2, a healthcare strategy and advisory firm, projected 37 percent of total joint surgeries would be outpatient by 2022, with that number rising to 51 percent by 2026.

11. Medicare pays $8,017 in an ASC, compared to $11,622 in an HOPD. Medicare beneficiaries without supplemental insurance have a copay of $2,003 in ASCs and $1,690 in HOPDs.

12. Artificial intelligence may be used to aid in clinical decision-making after 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 after surgery based on predicted outcomes. Read the full story here.

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

14. 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.

15. Surgery centers are increasingly acquiring robotic technology for total joint surgeries for more accurate procedures. In some cases, the technology can also be used as a surgeon recruitment tool for those who are familiar with the technology in the hospital. However, robotic technology is a large expense and may not make sense for all centers. Read more here.

 More articles on surgery centers:
What controversies have ENT talking? 3 expert insights
Wyoming ASC appoints new administrator
The 20 most common ASC procedures

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