— Not an actual patient/physician

The Benefits of Outpatient Joint Replacement Surgery

Because of COVID-19, you may feel nervous about having a procedure like joint replacement surgery at a facility that also tests and cares for coronavirus patients. If so, outpatient surgery may be something to consider.

Outpatient surgical facilities are also often referred to as ambulatory surgery centers (ASCs). These are advanced medical facilities that perform important diagnostic and prevention services as well as same-day surgical procedures. Outpatient procedures are not new, but the growing volume and increased number of services offered in outpatient settings means more people may have access to this form of care.

Patient Guide to Outpatient Joint Replacement

Did you know that some joint replacement procedures have the option for outpatient surgery? Click here for a free guide to outpatient joint replacement surgery.

Historical trends

There’s a growing trend in surgery, shifting from inpatient procedures where a hospital stay is necessary to outpatient procedures. Between 2005 and 2015, hospital inpatient admissions declined by 6.6.%, while outpatient visits grew by 14%. During this same period, outpatient services per Medicare beneficiary increased by 47%, according to the Medicare Payment Advisory Commission (MedPAC).2 The trend is even present in orthopedic procedures, which historically occurred almost exclusively as inpatient surgeries.3 This shift is driven by advances in technology, desires to offer specialized care, and the need to reduce healthcare costs and inefficiencies.

Current context (COVID-19)

While managing patient care and trying to limit the spread of infectious diseases is not new in healthcare, many people acknowledge the rise of COVID-19 presents a unique set of challenges. Hospitals try to manage testing and care of patients with the virus, while not exposing others coming to seek treatment for unrelated conditions (diabetes, liver disease, etc.), newborn delivery, and more.

For approved patients, outpatient procedures offer a solution in limiting exposure. In the case of joint replacement, many outpatient facilities are dedicated solely to treating orthopedic cases. This means that the doctors, nurses, and staff would likely not be directly caring for active, COVID-19 positive patients while administering your care. Additionally, you don’t have to trade your quality of care to have your surgery performed in an outpatient setting rather than a hospital.1

Results

It’s natural to have some reservations about having a surgical procedure performed outside of a hospital. Although joint replacements are fairly common, you may want assurances that you won’t be disappointed or have an increased risk of complications in an outpatient setting.

Two studies have demonstrated higher patient satisfaction in patients that have their orthopedic procedure done in an outpatient setting instead of an inpatient setting.1,4 This may be, in part, due to lower complication rates for certain orthopedic procedures.6 Another study reported that patients felt there were better explanations of medications, better assistance with pain management, higher quality post-surgical discharge materials, and increased feelings of respect and courtesy from nurses in outpatient settings versus inpatient settings.7

As with any surgical procedure, there are associated risks. For more information on the risks associated with joint replacement, click the appropriate link below.

Cost savings

Did you know that outpatient centers can be 45-60% less expensive than hospitals? 1,5 The average price for a knee replacement in an inpatient setting is $30,249 compared to $19,002 for those done outpatient.6 That’s a difference of $11,247. The average cost of an inpatient hip replacement is $30,685, compared to an outpatient hip replacement average of $22,078.6 A savings of $8,607.

In fact, a Berkeley study comparing procedures from 2008 to 2011 found that ASC’s/outpatient centers saved Medicare $7.5 billion dollars!11 The Department of Health and Human Services has estimated that if surgeries were performed at ASC rates versus at hospital rates, taxpayers would save $15 billion and patients would save $3 billion for those patients on Medicare.2 The same report estimates that outpatient surgical centers have the potential to save the Medicare program and its enrollees up to $57.6 billion over the next 10 years.2 This is largely due to the charges associated with overnight stays, nursing costs, etc. As patients are increasingly responsible for out-of-pocket healthcare costs, the reduction in healthcare spend by opting to have joint replacement done in an outpatient surgical center may be an important consideration. 8-10

Conclusion

There are many benefits to outpatient joint replacement, but not all patients qualify for outpatient surgery. Those with a history of heart disease, lung disease, or other complex conditions may be better served by having their surgery occur in a hospital. Be sure to talk to your doctor to learn more about outpatient procedures and whether or not you qualify. If you need assistance finding a doctor, click here.

References
  1. Crawford, D., et al. (2015, Dec 28). Clinical and Cost Implications of Inpatient Versus Outpatient Orthopedic Surgeries: A Systematic Review of the Published Literature. Orthopedic Reviews PagePress. 7(4): 6177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703913/
  2. Levinson, D. (2014, Apr). Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates. United States, Department of Health and Human Services, Office of Inspector General. https://oig.hhs.gov/ 
  3. Ambulatory Surgery Centers: A Positive Trend in Health Care (2012, May 23). Ambulatory Surgery Center Association. https://www.ascassociation.org/asca/communities/community-home/librarydocuments/viewdocument?DocumentKey=7d8441a1-82dd-47b9-b626-8563dc31930c.
  4. Krywulak, S., et al. (2005, Jun). Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: A randomized clinical trial. Can J Surg. 48(3): 201-206. https://www.ncbi.nlm.nih.gov/pubmed/16013623
  5. Levitt, L. (2017, Jun 15). The Benefits of Outpatient Surgical Centers. The Centers for Advanced Orthopedics. https://www.cfaortho.com/media/news/2017/06/the-benefits-of-outpatient-surgical-centers
  6. Planned Knee and Hip Replacement Surgeries Are On The Rise In The US (2019, Jan 23). Blue Cross Blue Shield. https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HoA-Orthopedic%2BCosts%20Report.pdf
  7. Kelly, M., et al. (2018, Nov). Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction? Journal of Arthroplasty. 33(11): 3402-3406. https://www.ncbi.nlm.nih.gov/pubmed/30143333
  8. Providers Driven to Implement Patient-Centric Financial Solutions as Consumer Payment Responsibility Skyrockets 29 Percent, Black Book Research (2017, Oct 24). Newswire. https://www.newswire.com/news/providers-driven-to-implement-patient-centric-financial-solutions-as-20015628
  9. Kary, T. (2017, Nov 27). Next U.S. Restructuring Epidemic: Sick Health-Care Companies. Bloomberg. https://www.bloomberg.com/news/articles/2017-11-27/next-u-s-restructuring-epidemic-sick-health-care-companies
  10. Anderson, D. (2017, Jun 13). InstaMed Releases Seventh Annual Trends in Healthcare Payments Report. InstaMed. https://www.instamed.com/news-and-events/seventh-annual-trends-in-healthcare-payments-report/
  11. Medicare Cost Savings Tied to Ambulatory Surgery Centers (2013, Sep 10). Ambulatory Surgery Center Association and the University of California Berkeley. https://www.ascassociation.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=7b33b916-f3f1-42e5-a646-35cc2f38fe4d
Please let us know how useful this article was to you

Thank you for rating this article.