Financial Considerations for Surgeons in the Outpatient Setting: Costs and Ownership Models

Abstract

In conjunction with the clinical and patient care aspects of an arthroplasty program, the economic reality of performing total joint arthroplasty (TJA) in an ambulatory surgery center (ASC) must also be addressed. Medicare and commercial payers see the cost benefits and the positive outcomes associated with performing total joints in ASCs. Accordingly, many surgery centers have successfully renegotiated commercial payer contracts and “carved out” the applicable arthroplasty CPT codes. However, it must be emphasized that negotiating payer contracts is only one, albeit a critical, factor when developing and growing an outpatient TJA program. There are a myriad factors inherent in establishing a successful arthroplasty program; thus, it is not as simplistic as adding yet another service line to the ASC, such as ophthalmology or endoscopy. The obvious differentiator is that high-cost implants are utilized; however, there are other factors that must be considered in order to develop a comprehensive and successful program.