Total Knee Arthroplasty in Ambulatory Surgery Centers: The New Reality!

Abstract

By streamlining surgical care and eliminating postoperative hospitalization, the transition to ambulatory total knee arthroplasty (TKA) has the potential to improve efficiency and minimize the costs of care. However, practical, legal, and financial implications remain to be addressed. The Centers for Medicare and Medicaid Services has also yet to address concerns generated by the removal of TKA from the Inpatient-Only List and provide guidance on patient selection. Rolling out regulatory changes that impact highvolume procedures, such as TKA, in a short period of time and without appropriate feedback can only lead to further confusion. As surgeons, we are in a unique business model that requires us to constantly innovate to deliver high quality care, while also taking financial cuts as a result of our innovations.

The Initial Impact of COVID-19 on Total Hip and Knee Arthroplasty

“…There have been recent dramatic changes in the field of arthroplasty prior to COVID-19 in regards to reimbursement and clinical care. This has included the removal of total knee arthroplasty (TKA) from the Centers for Medicare and Medicaid Services (CMS) inpatient only (IPO) list and subsequent approval as an Ambulatory Surgery Center (ASC) qualified procedure [ 12 , 13 ]. CMS also removed total hip arthroplasty (THA) from the IPO list in January, 2020, 3 months prior to pandemic [ 14 ].…”

Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

“…Our results are clinically important given the current shift of practice towards the performance of total knee replacement in the outpatient setting [ 20 ]. Given the current financial incentives and economic pressures to reduce costs, it is expected that the number of outpatient total knee replacement procedures are expected to grow substantially over the following years [ 21 ].…”

Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures

“…From a resource utilization standpoint, LOS variation impacts the ability to offer elective and nonelective services to additional patients, while also fiscally creating burdens for services with fixed reimbursement schedules, regardless of the numbers of hospitalization days [2]. Attempts to transition appropriate elective surgical procedures from hospital admission status to same day surgery have been moderately successful from the perspectives of both patients and healthcare delivery systems [3][4][5]. Unfortunately, a significant proportion of elective surgeries, especially those involving orthopedic or cancer care, still require some form of inpatient hospitalization.…”

“…Attempts to transition appropriate elective surgical procedures from hospital admission status to same day surgery have been moderately successful from the perspectives of both patients and healthcare delivery systems [ 3 - 5 ]. Unfortunately, a significant proportion of elective surgeries, especially those involving orthopedic or cancer care, still require some form of inpatient hospitalization.…”