Healthcare’s evolution toward value-based care and risk-sharing payment models is prompting many hospitals to take a new look at moving total joint replacement (TJR) surgery to outpatient settings, including ambulatory surgery centers (ASCs), as a transformational strategy with potential to improve both bottom-lines and quality of care.
While the shift to performing TJR in outpatient settings is gaining support as a viable option for some patients, made possible by the development of less invasive surgical techniques, progress doesn’t come without some challenges. An article published recently on ModernHealthcare.com explores friction between surgeons and hospitals surrounding the trend, and raises questions about the premise of Medicare’s new bundled-payment initiative for hospital-based procedures.
The article suggests moving TJR procedures to outpatient setting poses a threat to hospital finances, since TJR surgeries are one of the largest and most profitable service lines at many hospitals. In 2014, the article reports, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing the government more than $7 billion for the hospitalizations alone – over $50,000 per case.
The financial threat to hospitals will be even greater if the U.S. government’s Centers for Medicare and Medicaid Services (CMS) changes its rules to allow Medicare and Medicaid payment for these procedures. A migration of TJR to outpatient settings could also undercut Medicare’s hospital bundled payment initiative.
Despite these hurdles, the article reports the number of surgeons eager to perform TJR surgeries outside the hospital is increasing, driven by patients’ and payers’ desire to reduce costs, increase convenience and satisfaction and diminish the risk of hospital-acquired infections. And, the article concludes, experts expect payers to embrace the trend as more patients opt for having these procedures done in the less expensive outpatient setting, reducing their out-of-pocket costs under high-deductible health plans.
“Moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial,” says Regent Surgical Health CEO Chris Bishop. “But it’s critical to assess outcomes on an inpatient versus outpatient basis, and to measure whether the results of these procedures vary by setting type or even provider.”
Regent Surgical Health offers unmatched experience structuring strong ASC joint venture partnerships. An experienced manager and developer of ASCs across the United States and Europe, Regent’s leadership team helps develop new centers, and also, can assist with strategies for immediate improvement in the financial health of an existing facility.
“As value-based care goals drive the movement of additional types of surgery from hospitals to ASCs, we are seeing a shift in how hospitals view their outpatient strategy,” Bishop says. “It is no longer a matter of migrating a percentage of the hospital’s outpatient volume to secure higher acuity inpatient volume. ASCs are now seen as a low cost, high quality component of the system’s care model of the future.”
For more information, download Regent’s white paper, “Outpatient Joint Replacement & Two Additional Developments Transforming the Ambulatory Surgery Center (ASC) Industry,” at http://regentsurgicalhealth.com/outpatient-joint-replacement-in-hospital/.