Now that Medicare has caught up to private payers and opening up coverage policies to ambulatory surgery centers, experts see the procedure migration to ASCs accelerating.
The shift of procedures from the hospital to outpatient settings has gained momentum in recent years as commercial insurers boosted coverage and surgeons warmed to the idea of treating patients in ambulatory surgery centers.
Now that Medicare is catching up to this trend, experts expect the outpatient procedure migration to speed up with medical device companies like Stryker and Zimmer Biomet looking to capitalize on this shift, particularly in the orthopaedic space.
Bain & Company in a 2019 report, projected the percentage of hip procedures in ASCs to grow from just over 9% to 25% by the mid-2020s and knee procedures to grow from 10% to 30%.
While hospitals have opposed the moves, in part citing safety risks, Medicare seems to agree.
CMS recently finalized a Medicare rule that moved 11 services onto the ASC covered procedures list, including total hip replacements. The agency also finalized new criteria for the covered procedures list, which will cover about 267 musculoskeletal-related services when conducted in outpatient settings. In addition, CMS finalized a three-year phase-out plan of the inpatient only list.
Stryker has been looking to capitalize on the movement of surgeries as it has been accelerating over the last decade or so.
“This is definitely the continuation of a trend that started long ago, and we anticipate will continue well into the future,” said Nate Miersma, Styker’s senior director of ASC.
All of these moves continue CMS’ embrace of outpatient care, which the agency says can help lower overall healthcare costs while maintaining the same level of safety as an inpatient setting.
Analysts with Moody’s Investors Service wrote in a recent report that the final rule will ultimately “drive more highly profitable orthopedic procedures out of hospital inpatient settings.”
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