Will moving orthopedic procedures to freestanding facilities impact health care economics?
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Reimbursement trends need attention
The short answer to this question is “yes,” but orthopedic medicine is a complex, multifaceted collection of physicians, ancillary health care staff, hospitals, equipment manufacturers, insurance companies and government stakeholders, to name a few. So the manner in which the transition of orthopedics to a predominantly outpatient surgical subspecialty will impact health care economics is likely to unfold during the next several years. From the physician standpoint, this is the rare “win” for many of those stakeholders. By moving procedures to freestanding, usually outpatient, facilities, orthopedic surgeons are better able to control the service line and improve quality metrics. This creates better outcomes for patients and a lower cost of care, the very definition of health care value. This also translates into lower costs for employers providing private insurance and less cost to the taxpayer for government payers. However, careful attention will have to be paid to reimbursement trends. Early experience with outpatient total knee arthroplasty indicates that the CMS reimbursement code for ASC procedures is almost prohibitively decreased compared with reimbursement in the hospital setting. Private insurers and CMS should both be aware that the move toward outpatient orthopedic surgery can be a significant cost saver to the health care system, but reimbursement should not be restricted to the point where it prohibits surgeon participation and/or compromises patient care.
Thomas W. (Quin) Throckmorton, MD, is a professor of shoulder and elbow surgery in the department of orthopedic surgery at the University of Tennessee-Campbell Clinic in Germantown, Tennessee.
Has impact on economics, outcomes
Moving orthopedic procedures, especially TJA and spine procedures, will have a significant impact on, not only health care economics, but on outcomes and patient satisfaction. The evidence regarding TJA is especially compelling. Sg2, a health care and hospital system consultancy, estimated that more than 50% of TJAs would be done in the ASC setting by 2026, but that may underestimate the migration. Some practices in the United States currently perform more than 70% of their TJA volume in their practice-owned ASCs, which includes cases that involve Medicare patients. This reverts control of the clinical episode of care to orthopedic surgeons and allows them to extract more value by controlling both the clinical and economic aspects of care. It can be a triple win of better outcomes, cost containment and increased revenue for surgeons. Also, patient satisfaction is improved. A study by Kathleen Carey, PhD, and colleagues demonstrated an almost 14% decrease in costs with migration to the outpatient setting for both THA and TKA. Patient outcomes were improved and complications decreased with this selected outpatient population. Savings with outpatient cases can be as much as 30% in some localities. This is changing the way orthopedic practices interface with insurance companies with increased collaboration and reconciliation of postoperative costs. Some practices market episodic services directly to brokers for self-insured employers, which is another paradigm shift and opportunity. For practices that own and control an ASC, this migration is essential for their future. The more orthopedic surgeons own and control the “means of production” in delivering care, the more valuable they will be to employers, insurers and patients.
- Are you prepared for the shift to outpatient total knee replacement? Available at: www.sg2.com/health-care-intelligence-blog/2016/10/prepared-shift-outpatient-total-knee-replacement/. Accessed July 13, 2021.
- Carey K, et al. J Arthroplasty. 2020;doi:10.1016/j.arth.2019.08.041.
Louis F. McIntyre, MD, is the chief quality officer of US Orthopaedic Partners and is an Orthopedics Today Editorial Board Member.