Becker's ASC Review

18 ORTHOPEDIC SECTION 16 Things to Know About Outpatient Total Joint Replacements and ASCs By Laura Dyrda H ere are 16 things to know about outpa- tient total joint replacements and am- bulatory surgery centers. 1. Outpatient total joint replacements are on the rise; according to Sg2, from 2012 to 2015, there was a 47 percent increase in elective outpatient hip and knee replacement procedures as report- ed by Vizientinc. Sg2 predicts there will be 77 percent growth in joint replacements over the next 10 years, but inpatient total joint replace- ments are only projected to grow 3 percent over the same time period. 2. Outpatient total joint replacement is expected to increase 457 percent for knee replacements and 633 percent for hip replacements nationally in the next decade, according to Sg2. 3. e projected outpatient volume for joint replacement, including partial and total joint replacements, for the next decade are as follows: • 2016: 15 percent • 2018: 25 percent • 2020: 32 percent • 2022: 37 percent • 2024: 43 percent • 2026: 51 percent 4. Nearly half of the total joint population to date spends one to two days in the hospital, according to Sg2; these patients are "ripe for the shi to the outpatient setting." Hospitals are concerned they will see decreased revenues due to outpatient procedures or cases moving into ASCs. 5. An Advisory Board Company analysis found 23 percent of hospitals, out of 354 hospitals sur- veyed, perform some outpatient total joints; 7 percent perform at least some outpatient hip replacements. e surgeons performing those outpatient procedures said "very few of their patients need skilled nursing, rehabilitation or home care" aer their procedures. 6. In 2014, Medicare paid $50,000 on average per hospitalization for total hip and knee re- placements, according to Advisory Board, to- taling around $7 billion. However, outpatient total joints cost "roughly half as much" as in- patient procedures, which could be a driving force to the outpatient setting for appropriate patients in the future. 7. Total knee and hip replacements were among the first procedures to transition to bundled pay- ments because they are elective procedures with reproducible outcomes. Physicians and provid- ers are able to control much of the care deliv- ered and there is room for cost savings in these procedures. CMS implemented Comprehensive Care for Joint Replacement bundled payments for hospitals in select geographies, and in some regions ASCs are considering bundles. "Determine how merging your ambulatory and bundled payment strategies can create an at- tractive fixed fee-offering for commercial pay- ers and local employers to influence referral channels," advised the Sg2 report. 8. President Donald Trump signed an executive order to begin dismantling the ACA on his first day in office, and it could have an impact on CMS bundled payments. CMS expanded their hip and knee replacement bundles for 2017, but aer the executive order, the Congressional Re- search Services sent a memo to postpone any new regulations published on the Federal Reg- ister, but not implemented, for 60 days. Additionally, the new HHS Secretary Tom Price, MD, has been a critic of the Center for Medicare and Medicaid Innovation, which produced CJR. However, the bundled payment program enjoyed bipartisan support in Congress in the past. 9. CMS currently doesn't reimburse for total joint replacement in ASCs, but the Advisory Panel on Hospital Outpatient Payment unani- mously recommended CMS remove total knee replacement from the inpatient only list in 2016. CMS also requested additional informa- tion on how feasible it would be to remove the procedure in the 2017 payment rule, indicating the agency could take steps toward reimburse- ment for outpatient total joints in the future. 10. ASC companies are working with their cen- ters to add outpatient total joints. SurgCenter Development reported nearly 7,000 total joint replacements were performed in their 107 ASCs across the United States in 2016, and es- timate that number will grow this year. Ninety- six percent of those procedures were same-day discharges. Surgical Care Affiliates, Regent Sur- gical Health, Meridian Surgical Partners and United Surgical Partners International/Tenet also have ASCs performing total joints. 11. In May 2016, SCA partnered with Swi- Path, a platform that develops evidence-based, rapid recovery protocols for outpatient total joint replacements as well as provides patient education, selection criteria and peer-reviewed surgical techniques. In its third quarter finan- cial report for 2016, SCA reported total joint re- placements performed at its facilities more than doubled year-over-year, and the company had 37 facilities performing outpatient total joints. 12. Pacific Rim Outpatient Surgery Center in Bellingham, Wash., celebrated 10 years of total joint replacements last year. e ASC launched its total joint replacement program in 2005 with just one payer; in 2014, the ASC began working with Blue Cross Blue Shield to cover total joints. Avanza Healthcare Strategies President and CEO Joan Dentler sees more payers willing to contract for total joints in outpatient ASCs in the future. "For ASCs to remain successful in this challeng- ing healthcare environment, it is critical that they develop strong relationships with payers," says President and CEO of Avanza Healthcare Strat- egies Joan Dentler. "As payers look to further reduce their costs, surgery centers are becoming an even more attractive facility to provide care to members. To not only remain in the payer's network but also receive appropriate reimburse- ment and coverage for 'new' procedures, such as spine and total joints, ASCs must closely track their financial outcomes data and be prepared to 5 Statistics on Orthopedic Net Revenue Per Case at ASCs By Laura Dyrda H ere are five statistics on net revenue per case for ortho- pedic cases at surgery cen- ters, according to the VMG Health 2016 Intellimarker Multi-Specialty ASC Study. 1. Mean net revenue per case: $3,452 2. 25th percentile: $2,466 3. Median: $3,222 4. 75th percentile: $4,108 5. 90th percentile: $5,082 n

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