The Pipeline

Outpatient joint replacement: Pipe dream or inevitability?

Samuel Gold, Technology Insights

Outpatient joint replacement has been on the minds of many orthopedic planners recently, and its appeal is clear: Offering joint replacements in an outpatient setting potentially adds levels of convenience and efficiency to an already historically efficacious and lucrative surgery. 

There are a number of factors that could contribute to the increased adoption of this procedure including, but not limited to a younger, healthier joint replacement patient base, patient preference towards outpatient surgeries, and increased competition from ambulatory surgery centers for orthopedic business.

Risks and rewards

Offering outpatient joint replacement, however, carries with it a variety of risks and considerations. To begin, joint replacement is a rather complex procedure making patient selection a priority. Only patients with strong health status without any risk of complication should qualify for this outpatient procedure. 

Likewise, the hospital must employ advanced multimodal pain management to be able to discharge these same-day patients without lingering effects from traditional anesthetics. An inpatient hospital stay also provides direct access to consistent physical therapy during the initial recovery days, which studies have shown to play an important role in shortening a patient’s rehabilitation.

Payment structure is an issue

Current payment structures also complicate the adoption of outpatient joint replacement. Generally, outpatient surgeries have lower costs than their inpatient equivalents, but they are also reimbursed at lower rates. In addition, CMS considers joint replacement to be reimbursable only for an inpatient stay. In 2012, this procedure was nearly removed from the “Inpatient only” list for the Medicare proposed rule. 

That change ultimately did not occur indicating that payers are still contemplating the feasibility of outpatient joint replacements. Finally, with outpatient procedure, there is an added risk of readmissions, which will be financially penalized with newer payment reforms coming into play.

An uncertain opportunity

Overall, outpatient joint replacements provide an intriguing opportunity to attract both patients and physicians to a hospital’s orthopedic business. 

However, there is still a great deal of uncertainty regarding the clinical and financial implications of adopting this procedure. It will be most important for orthopedic planners to continue monitoring any new financial developments while working closely with surgeons to ensure the hospital can provide the needed infrastructure and clinical support if outpatient joint replacement is in fact adopted.

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