The Changing Economic Value and Leverage of Arthroplasty Surgeons: How the Shift in Arthroplasty Surgery Location Impacts the Relationship of Private Surgeons, Hospitals, and Ambulatory Surgery Centers

Published:December 20, 2021DOI:https://doi.org/10.1016/j.arth.2021.12.016

      Abstract

      The recent removal of total hip and knee arthroplasty from the Medicare inpatient-only list, COVID-19 pandemic, decreasing reimbursements, and bundled payment programs have all had tremendous impact on the practice of arthroplasty. Surgeons and practices must adapt to these challenges to achieve the ideal triad of quality patient care, low cost to payors, and sustainable financial margins for stakeholders. Here, we review institutional data and present our experience with the changing arthroplasty practice landscape. With the principle of demand matching, arthroplasty surgeons and practices can risk-stratify and shuttle patients in the appropriate operative and rehabilitation setting to optimize quality and efficiency.

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      References

        • Krueger C.A.
        • Austin M.S.
        • Levicoff E.A.
        • Saxena A.
        • Nazarian D.G.
        • Courtney P.M.
        Substantial preoperative work is unaccounted for in total hip and knee arthroplasty.
        J Arthroplasty. 2020; 35: 2318-2322
        • Grosso M.J.
        • Courtney P.M.
        • Kerr J.M.
        • Della Valle C.J.
        • Huddleston J.I.
        Surgeons’ preoperative work burden has increased before total joint arthroplasty: a survey of AAHKS members.
        J Arthroplasty. 2020; 35: 1453-1457
        • Vega A.N.
        • Ziemba-Davis M.
        • Hicks S.A.
        • Meneghini R.M.
        • Buller L.T.
        Time required for planned and unplanned episodes of care in primary total joint arthroplasty: has anything changed with a growth in outpatient arthroplasty?.
        J Arthroplasty. 2021; 36: 1195-1203
        • Gronbeck C.J.
        • Cote M.P.
        • Halawi M.J.
        Predicting inpatient status after total hip arthroplasty in Medicare-aged patients.
        J Arthroplasty. 2019; 34: 249-254
        • Theosmy E.
        • Yayac M.
        • Krueger C.A.
        • Courtney P.M.
        Is the new outpatient prospective payment system classification for outpatient total knee arthroplasty appropriate?.
        J Arthroplasty. 2021; 36: 42-46
        • Krueger C.A.
        • Yayac M.
        • Vannello C.
        • Wilsman J.
        • Austin M.S.
        • Courtney P.M.
        From winners to losers: the methodology of bundled payments for care improvement advanced disincentivizes participation in bundled payment programs.
        J Arthroplasty. 2021; 36: 1204-1211
        • Yayac M.
        • Schiller N.
        • Austin M.S.
        • Courtney P.M.
        The Knee Society 2020 John N. Insall Award: removal of total knee arthroplasty from the inpatient-only list adversely affects bundled payment programmes.
        Bone Joint J. 2020; 102: 19-23
        • Curtin B.M.
        • Odum S.M.
        Unintended bundled payments for care improvement consequences after removal of total knee arthroplasty from inpatient-only list.
        J Arthroplasty. 2019; 34: S121-S124
        • Brubaker H.
        Wills Eye in Philly marks a huge win, regaining hospital status under Medicare.
        Philadelphia Inq, Philadelphia, PA2018
        • Lynch J.C.
        • Yayac M.
        • Krueger C.A.
        • Courtney P.M.
        Amount of CMS reduction in facility reimbursement following removal of total hip arthroplasty from the inpatient-only list far exceeds reduction in actual care cost.
        J Arthroplasty. 2021; 36: 2276-2280
        • Davis C.M.
        • Swenson E.R.
        • Lehman T.M.
        • Haas D.A.
        Economic impact of outpatient Medicare total knee arthroplasty at a tertiary care academic medical center.
        J Arthroplasty. 2020; 35: S37-S41
        • Iorio R.
        • Peavy P.R.
        • Keyes D.W.
        • Dempsey S.M.
        • McCready D.O.
        • Kang J.D.
        Improving arthroplasty efficiency and quality through concentrating service volume by complexity: surviving the Medicare policy changes.
        J Arthroplasty. 2021; 36: 3055-3059
        • Meneghini R.M.
        • Ziemba-Davis M.
        • Ishmael M.K.
        • Kuzma A.L.
        • Caccavallo P.
        Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score”.
        J Arthroplasty. 2017; 32: 2325-2331
        • Iorio R.
        • Healy W.L.
        • Appleby D.
        Preoperative demand matching is a valid indicator of patient activity after total hip arthroplasty.
        J Arthroplasty. 2004; 19: 825-828
        • Phillips J.L.H.
        • Rondon A.J.
        • Vannello C.
        • Fillingham Y.A.
        • Austin M.S.
        • Courtney P.M.
        A nurse navigator program is effective in reducing episode-of-care costs following primary hip and knee arthroplasty.
        J Arthroplasty. 2019; 34: 1557-1562
        • Krueger C.A.
        • Courtney P.M.
        Projections of the impact to arthroplasty surgeons with changes to the 2021 Medicare physician fee schedule—a looming crisis of access to care?.
        J Arthroplasty. 2021; 36: 2412-2417