Many orthopedic surgeons and ambulatory surgery center operators are delighted with the CMS’ mid-July announcement that it’s considering paying for total knee and hip replacement procedures in outpatient settings. But lots of hospital leaders are not.
“I did a knee today at 7:30 a.m., and the patient left at 12:30 happy and with pain under control,” orthopedic surgeon Dr. Louis Levitt said late last month; Levitt’s medical group owns Massachusetts Avenue Surgery Center in Bethesda, Md. “If Medicare approved this, it will be a substantial boon to our ambulatory surgery business, and physicians will get more comfortable with the idea.”
Hospital leaders are wary, however, for both financial and clinical reasons. They fear losing substantial inpatient revenue from total joint procedures—one of their bigger profit centers—to ambulatory surgery centers, as they’ve previously lost many other surgical procedures. In addition, they and doctors on staff aren’t necessarily comfortable at this point doing the operations in either hospital outpatient departments or ambulatory surgery centers.
“We haven’t seen a lot of data that would show performing those procedures in ambulatory centers with no inpatient stay would result in better outcomes,” said Sabra Rosener, vice president of government affairs for UnityPoint Health, which operates hospitals and clinics in Iowa, Illinois and Wisconsin.
A CMS decision to pay for total joint replacements in outpatient settings would speed the migration of these procedures out of the hospital, experts say. One big factor is it would embolden more private payers to start paying for the operations in ambulatory settings.
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