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Beckers ASC Review on ASCs and Total Joint Replacements

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Becker’s ASC Review writes the migration of total joint replacements to the outpatient and ASC setting following CMS payment updates with more studies showing the procedure can be performed safely in the outpatient setting. More than 500 ASCs currently offer total joint replacements in the U.S. California has the most ASCs performing total joint replacements, with 50 centers. Florida is No. 2, with 42 centers that have ASCs, followed by Maryland and Texas which each have 32 centers with performing total joint replacements.

Total joint surgery is more affordable in an ASC. A study from New York City-based Hospital for Special Surgery and Philadelphia-based Rothman Orthopaedics suggests there isn’t increased risk for patients undergoing outpatient joint replacements performed in the ASC setting when compared with the inpatient hospital setting. The surgery cost for the ASC group was 40 percent less than the hospital group detailed in the study. On average, outpatient surgery costs $11,677, and inpatient surgery costs $19,361.

Total knee replacement became eligible for Medicare payment in the ASC setting in 2020, and Medicare added total hip replacements in 2021. Moving half of routine total joint replacements from the hospital to ASC setting could yield $3 billion in annual savings, including $2 billion for privately insured individuals and employers as well as $1 billion for Medicare beneficiaries and the federal government, according to a report from UnitedHealth Group published in December 2020.

UnitedHealth Group’s study of more than 1.2 million hip and knee replacement surgeries found 90 percent of procedures for privately insured patients were performed in hospitals. However, surgical site infections were present in 2.5 percent of those patients and resulted in 26,000 patients having longer hospital stays and requiring additional treatment. Moving half of routine inpatient joint replacements could result in 500,000 fewer hospitalizations, according to the report.

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