Less time in the hospital setting. Lower costs. Better outcomes. Many reasons exist as to why patients are more frequently choosing to have complex surgeries, such as total joint replacements, performed at an outpatient surgery center.  As the tide shifts as do the regulations and payments concerning these procedures. Join us as we explore the recently introduced regulatory changes and the proposed rule from CMS regarding the fate of ambulatory surgery centers (ASCs).

Waiting area in an outpatient surgery center

As outpatient surgery center use continues to rise, as do the payment structures and regulations of these healthcare facilities.

Will Florida Allow 24-Hour Stays in Ambulatory Surgery Clinics?

A recent proposal by lawmakers in Florida has made a comeback, as it was reintroduced by Florida Sen. Greg Stuebe in the beginning of September (reported by News 4 Jax). The bill (SB 250) is intended to make patients legally able to stay in ambulatory surgery centers for up to 24 hours at a time.

The SB 250 bill was previously introduced and sparked debate, criticism, and increased attention on the regulation of the delivery of healthcare in the ambulatory surgery setting. While no decision has been made yet, the bill will fall under consideration in January of 2018, during the legislative session.

Current law in the state of Florida prohibits patients from staying overnight at an outpatient surgery center. While the house has pushed for this regulation change in recent years, thus far, the Senate has not allowed it. However, this time around the bill may have a better chance because Steube’s version of the bill does not authorize “recovery care centers” that allow up to 72-hour stays, as did previous attempts.

Demand Drives $1.7 Million Expansion Plans for Maryland Surgery Centers

In Maryland, the growing demand for more outpatient surgery options has Bethesda Chevy Chase Surgery Center LLC seeking the approval from the state for a $1.7 million expansion according to Biz Journals. The article in Biz Journals summarizes the request, “Officials at the physician-owned outpatient surgery center, located at 6931 Arlington Road in Bethesda, said they hope to acquire 3,027 square feet in their current building to add a second operating room. The center — which performs orthopedic, spine and pain management procedures — said its operating room has exceeded ‘optimal utilization,’ as defined by Maryland regulators, since 2012.”

CMS Proposes to Remove TKA from IPO and American Academy of Orthopaedic Surgeons Agrees

In late July 2017, CMS proposed CMS-1678-P, Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Changes for 2018. Within this set of proposed changes to reimbursements distributed to outpatient facilities is the removal of total knee arthroplasty (TKA) from the in-patient only (IPO) list.

While the push towards performing more complex surgeries in the outpatient setting for cost-efficiency and patient convenience grows – some have still been on the fence about whether Medicare should or will reimburse for surgeries such as TKA and total hip arthroplasty (THA) performed in outpatient facilities.

However, representatives from the American Academy of Orthopedic Surgeons (AAOS) released a press release endorsing the removal of TKA and encouraging also removing THA from the IPO list. President of the AAOS, William J. Maloney, MD, wrote in the letter to CMS:

“The determination of how to best provide adequate and timely care to a Medicare beneficiary should fall under the purview of the patient-surgeon relationship, as these are the individuals who shoulder the risk of these procedures. There has been significant movement toward performing TKA in the outpatient setting, and AAOS supports removal of TKA from the Medicare in-patient only list with several contingencies.”

Those contingencies include measures to thoroughly assess the patient’s health and well-being and determine which location, out-patient or in-patient, is more appropriate on a case-by-case basis.

Where do Professionals in Healthcare Industry Stand on CMS’ proposal?

Healthcare Dive explores where healthcare professionals stand on the proposal made by CMS to allow total joint replacements in the outpatient setting. Highlights from the article include:

  • In 2014, Medicare paid hospitals more than a total of $7 billion on more than 400,000 hip and knee replacements.
  • Opponents of the proposed changes to the Medicare Physician Fee Schedule wrote in the comments to the CMS proposal that this practice could put patient safety at risk.
  • Proponents of the change feel that it could provide more options for Medicare beneficiaries and save healthcare spending with less expensive centers for surgery.
  • Supporters also point out that private payers are already allowing elective outpatient knee and hip replacements to be done in the outpatient setting.

MD+DI interviewed Scott Zellner, Senior Director, U.S. Joint Reconstruction and Outpatient Marketing to gain insight about this shift and how his company would adapt to these changes. The following is a quote from the article that includes one of the questions and his response:

“MD+DI: How would the shift of orthopedic procedures, such as surgeries of the shoulder, hand, foot and ankle, from hospitals to ambulatory surgery centers impact patient care? Healthcare in general? Does DePuy Synthes support such a shift?”

“Zellner: We believe that innovation in the medical devices industry goes beyond any individual product. We are reinventing the way we do business and the ways we bring innovation to the marketplace to help shape the future of healthcare by partnering with our customers to address the triple aim that results in a better overall experience for them and their patients. DePuy Synthes offers a suite of solutions to help customers address topics such as bundled payments, data collection and analytics, reimbursement, single-sourcing, outpatient joint replacement, and the increasing use of biologics.”