Improving Arthroplasty Efficiency and Quality Through Concentrating Service Volume by Complexity: Surviving the Medicare Policy Changes

How the Shift in Arthroplasty Surgery Location Impacts the Relationship of Private Surgeons, Hospitals, and Ambulatory Surgery Centers

“…Establishing clear criteria for the determination of inpatient versus outpatient status are paramount. Iorio et al [12] reported their strategy for transitioning all primary, uncomplicated, and minimally invasive TJA to community-based hospitals while reserving the academic medical center for complex primaries or revisions and medically complex Medicare patients. Despite lower reimbursement per case, they reported that increased efficiency, lower hospital cost, and higher volume led to an increase in hospital-based revenue.…”

The COVID-19 Pandemic and Centers of Medicaid and Medicare Services Regulatory Reform Impact on Total Hip Arthroplasty Metrics

“…Physician shortages in primary care, anesthesia and surgical services have caused access problems both in primary care and in THA surgical care. 2,3 The aim of the current study is to assess the removal of THA from CMS's IPO J o u r n a l P r e -p r o o f 3 list and the simultaneous effect of the Covid-19 pandemic on THA demand, CMS finances, and delivery care pathway metrics, resulting in the rapid shift away from inpatient THA.…”

Identifying and Creating Value for Employed Arthroplasty Surgeons in an Era of Decreasing Reimbursement

“…Increasing patient access to outpatient THA and TKA seems to be a viable opportunity for employed arthroplasty surgeons to be an added value for their hospitals [10,25]. In 2018, only less than a quarter of all TKAs and THAs were performed as outpatient procedures.…”

“…That number has steadily increased and will likely be over 50% in many institutions in the near future [18,26]. Iorio et al showed improvements in the overall net margins for hospital systems when transitioning appropriate THA and TKA patients to outpatient/same-day discharges [25]. Employed surgeons can be in the driver's seat as leaders in their hospitals, helping to implement the changes necessary to allow for such a transition in care [10,27].…”

“…As this becomes more common for large hospital systems, employed surgeons should inquire if they are able to create an ASC, and if so, are they able to participate in its ownership. Most surgeons will find that autonomy and efficiency will increase with the ability to shape the care for their patients [25]. The ability of employed surgeons to display value and gain autonomy via these ventures is at the frontier of arthroplasty surgery [10].…”