Outpatient Hip and Knee Arthroplasty: Implications for Hospitals, ASCs, and Payers

Abstract

Hospitals, surgeons and payers have recognized the potential benefits to certain patients that outpatient total hip and total knee arthroplasty can provide. Outpatient total joint arthroplasty (TJA) allows for a safe, cost-effective pathway for appropriately selected patients that is projected to increase significantly in prevalence in the coming years. The transition of more TJA surgeries from the inpatient to outpatient setting will have significant effects on hospitals, ambulatory surgery centers (ASCs), and payers. In general, ASCs stand to make financial gains as their market share of TJA increases, but TJA patients will present new challenges for them that they will have to adapt to. Payers also stand to gain financially as they reimburse less for TJA episodes of care. Hospitals are likely to incur financial losses as they are reimbursed less and as they lose healthy patients to the outpatient setting and their inpatient TJA patient cohort becomes sicker and costlier on average. In addition, there are likely to be unintended consequences on bundled payment models that may affect all of these stakeholders.