CMS Proposes Joint Replacement Coverage at ASCs

CMS Proposes Joint Replacement Coverage at ASCs

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By  | August 14, 2017

CMS announced on August 5 that they are considering whether to provide coverage for hip and knee replacement surgeries at outpatient surgery centers.

This kind of coverage could further incentivize patients to choose ambulatory surgery centers (ASCs) over traditional hospitals for outpatient procedures, which worries some hospital leaders. Not only could hospitals stand to lose revenue for joint replacement surgeries, a substantial portion of their income, but many doctors do not yet feel comfortable performing some of these operations in outpatient settings.

Just last year, the Advisory Panel on Hospital Outpatient Payment unanimously agreed that CMS should remove total knee replacement from the inpatient only list. However, not all patients are good candidates for outpatient total joint replacement surgeries, and surgeons should take into consideration a patient’s age, BMI, and overall health before opting for outpatient surgery.

It is estimated that demand for joint replacement surgeries will grow 77 percent over the next 10 years, but only 3 percent of these are predicted to be inpatient procedures. Currently only about half of joint replacement patients spend 1-2 days in the hospital while recovering, leading experts to believe that outpatient joint replacements are a respectable option for outpatient surgery centers.

 

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