Becker's ASC Review

40 ORTHOPEDICS 14 things to know about total joint replacements and ASCs for 2020 By Rachel Popa T he volume of total joint replacements in ASCs is increasing. e shi 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. Fourteen key details to know about total joint replacement in ASCs: 1. Over 300 ASCs offer total joint replacements in the U.S. 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. e 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 replace- ment cases in 2019. Here are a few noteworthy examples: - Steindler Orthopedic Clinic is now offering total knee replace- ments 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 aer they're discharged home. 5. At least seven ASCs acquired surgical robots for joint replacement in 2019. 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 Pay- ment 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. e 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, accord- ing 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 aver- age payments for select procedures in both settings. e 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, com- pared to $2,116 in an HOPD. Medicare beneficiaries without supple- mental insurance have a copay of $256 in ASCs and $529 in HOPDs. 10. Artificial intelligence may be used to aid in clinical decision-mak- ing following total joint replacement surgeries, according to a study from the New York City-based Hospital for Special Surgery. e 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. 11. A bundled payment program can lower 90-day episode of care costs for Medicare patients undergoing total hip and knee arthro- plasty, according to research published in the Journal of Arthroplasty. e 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). 12. In 2019, Humana and Towson, Md.-based SurgCenter Develop- ment entered into an agreement adding more than 100 SurgCenter Development locations to Humana's national provider network. e 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. e number of knee replacements performed has in- creased 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 ser- vices shiing 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. n

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