The Removal of Total Hip and Total Knee Arthroplasty From the Inpatient-Only List Increases the Administrative Burden of Surgeons and Continues to Cause Confusion

A Novel Machine Learning Predictive Tool Assessing Outpatient or Inpatient Designation for Medicare Patients Undergoing Total Knee Arthroplasty

“…In another AAHKS survey, Krueger et al. demonstrated that 81% of respondents noted an increase in their practice’s administrative burden after TKA was removed from the inpatient-only list [ 18 ]. More than half of surgeons surveyed needed to obtain preauthorization or appeal a denial for an inpatient TKA on a monthly basis.…”

“…More than half of surgeons surveyed needed to obtain preauthorization or appeal a denial for an inpatient TKA on a monthly basis. Within 2 years of the removal of TKA from the inpatient-only list, 10% of respondents had already been subjected to audits [ 18 ]. In a study published by Iorio et al., the authors demonstrated that their institution had already been subjected to 2 quality improvement audits since the 2018's inpatient-only removal of TKA [ 19 ].…”

“…Not only is the confusion of inpatient vs outpatient designation a burden to hospitals and providers, but nearly a third of surgeons stated that their patients have had additional personal costs after their TKA, due to the preoperative surgical classification being designated as an outpatient procedure [ 17 ]. In a subsequent survey conducted by AAHKS, 61% of patients contacted the primary surgeon’s office because of an unexpected copayment [ 18 ]. Iorio et al.…”

“…In an effort to ease potential hospital losses, due to classifying all patients undergoing TKA as an outpatient, the authors have used machine learning to justify inpatient designation, without fear of potentially destructive audits. CMS has not provided details on how patients should be designated for admission status, and surgeons have been extremely cautious in categorization to decrease their chances of serious financial consequences [ [18] , [19] , [20] , [21] ]. Krueger noted the aforementioned idea to make the decision as to which patients should receive an inpatient or outpatient designation more of an art than science [ 18 ].…”

“…TKA was removed from this list in 2018, and total hip arthroplasty was removed in 2020. There have been numerous consequences to removing TKA from the inpatient-only list [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. Providers and hospital administration face the added pressure in classifying most TKAs as an outpatient procedure, to avoid potential financially damaging audits.…”