Healthy patients fearful of COVID-19 exposure in a hospital are flocking to ambulatory surgery centers and specialty hospitals for their hip and knee replacements, creating an unprecedented two-fold spike in outpatient total joint replacement volume, according to Michael Ast, MD, orthopedic surgeon and chief medical innovation officer at Hospital for Special Surgery (HSS) in New York City. Dr. Ast estimates that freestanding ASCs set up for total joint surgeries are handling about half, and in some cases up to 80%, of joint replacement surgeries. This is in stark contrast to the more gradual increase in total joint procedures migrating to an ambulatory setting over the last 10 years — starting with around 5% of the total market in 2012 and increasing to around 35% by 2019. Dr. Ast predicts the current patient-driven spike in outpatient total joints will expand to other surgeries and drive the need for more freestanding specialized surgical facilities.
The original catalyst for outpatient total joints has been forward-thinking orthopedic surgeons like Dr. Ast who have paved the way with standardized care pathways offering rapid recovery, short-stay outpatient surgeries and lower costs compared to inpatient procedures. The effectiveness and efficiency of this economic approach has garnered significant attention from payers for some time, with Medicare approval for outpatient total joint replacements dating back to January 2020.
Anthony Mascioli, MD, an orthopedic surgeon at the multicenter Campbell Clinic in Memphis, Tenn., is recognized as a pioneer in outpatient total joint surgery. He helped refine surgical technique, establish standardized care pathways and develop a proven algorithm for patient selection to make these cases successful in an ambulatory setting. Dr. Mascioli and his practice colleagues also worked to share outcome measures for these procedures through the National Quality Forum and even worked directly with payers, starting in 2015, to establish the first outpatient Diagnosis Related Groups (DRGs) for total knee and total hip replacements.
With patient demand high, surgical technique and standardized care pathways established, and payer reimbursement steadily aligning, the volume of total joint surgeries in the ambulatory setting will likely only continue to increase, and facilities need to be ready to capitalize on the surge.