Patient Outcomes Following Total Joint Replacement Surgery: A Comparison of Hospitals and Ambulatory Surgery Centers
Affiliations
- PMID: 31526700
- PMCID: PMC6910922
- DOI: 10.1016/j.arth.2019.08.041
Abstract
Background: For several years, many orthopedic surgeons have been performing total joint replacements in hospital outpatient departments (HOPDs) and more recently in ambulatory surgery centers (ASCs). In a recent shift, the Centers for Medicare and Medicaid Services began reimbursing for total knee replacement surgery in HOPDs. Some observers have expressed concerns over patient safety for the Medicare population particularly if Centers for Medicare and Medicaid Services extends the policy to include total hip replacement surgery and coverage in ASCs.
Methods: This study used a large claims database of non-Medicare patients to examine inpatient and outpatient total knee replacement and total hip replacement surgery performed on a near-elderly population during 2014-2016. We applied propensity score methods to match inpatients with ASC patients and HOPD patients with ASC patients adjusting for risk using the HHS Hierarchical Condition Categories risk adjustment model. We conducted statistical tests comparing clinical outcomes across the 3 settings and examined relative costs.
Results: Readmissions, postsurgical complications, and payments were lower for outpatients than for inpatients. Within outpatient settings, readmissions and postsurgical complications were lower in ASCs than in HOPDs but payments for ASC patients were higher than payments for HOPD patients.
Conclusion: Our findings support the argument that outpatient total joint replacement is appropriate for select patients treated in both HOPDs and ASCs, although in the commercially insured population, the latter services may come at a cost. Until further study of outpatient total joint replacement in the Medicare population becomes available, how this will extrapolate to the Medicare population is unknown.
Keywords: ambulatory surgery center; complications; hospital outpatient; joint replacement; payments.
Copyright © 2019 Elsevier Inc. All rights reserved.
Similar articles
- Payments for outpatient joint replacement surgery: A comparison of hospital outpatient departments and ambulatory surgery centers.Health Serv Res. 2020 Apr;55(2):218-223. doi: 10.1111/1475-6773.13262. Epub 2020 Jan 23.PMID: 31971261
- Primary single-level lumbar microdisectomy/decompression at a free-standing ambulatory surgical center vs a hospital-owned outpatient department-an analysis of 90-day outcomes and costs.Spine J. 2020 Jun;20(6):882-887. doi: 10.1016/j.spinee.2020.01.015. Epub 2020 Feb 7.PMID: 32044429
- Ambulatory surgery centers and interventional techniques: a look at long-term survival.Pain Physician. 2011 Mar-Apr;14(2):E177-215.PMID: 21412380 Review.
- Recommendations of the Medicare Payment Advisory Commission (MEDPAC) on the Health Care Delivery System: the impact on interventional pain management in 2014 and beyond.Pain Physician. 2013 Sep-Oct;16(5):419-40.PMID: 24077189 Review.
- Saga of payment systems of ambulatory surgery centers for interventional techniques: an update.Pain Physician. 2012 Mar-Apr;15(2):109-30.PMID: 22430649
No hay comentarios:
Publicar un comentario