This piece was last updated on 4/5/24 to reflect current information and statistics.
With a major shift toward value-based care, procedures are moving out of the hospital setting and into ASCs. However, some procedures have moved faster than others, unlike joint replacement surgeries.
“Over the past 5 years, there has been a lot of discussion about outpatient ASC joint replacements,” Steve Lucey, M.D. of Atrium Health said in an Aug. 31st Becker’s article. “With all the emphasis on value-based care, joint replacement has been targeted as an opportunity to reduce cost by movement from inpatient to outpatient admissions. As a result, there is a reduction in skilled nursing admissions and decreased home health utilization.”
Lucey notes three major issues slowing the shift from hospital outpatient departments (HOPD) to ASCs:
- Shifting the site of care;
- Alignment between surgeons, payors, and ASCs;
- Determining if a patient is suited for treatment in an ASC.
Shifting the Site of Care
Of course, making a major move to shift care from a hospital setting to an ASC is a large undertaking. Lucey notes that making this transition requires rethinking the process of preparing a patient for a procedure, and those involved in the procedure itself.
“You still have the safety net of the big hospital; you still have your same staff, same rooms and it is, in fact, cheaper with a reduced facility fee/DRG payment,” Lucey said. “However, to move it to the most cost-effective venue of the outpatient surgery center requires an entirely new care paradigm, from pre-admission testing to patient education, staffing, sterile processing, care management, etc.”
This change in care process can be difficult at first. However, it typically results in cost savings for patients and better financial outcomes for physicians..
Improved Alignment
To move out of a hospital setting, all systems and processes must first be understood. This creates greater alignment between surgeons, ASCs, and payors. Creating and refining these aspects of care can be time consuming and difficult, making it a major reason why large volumes of joint replacement procedures have yet to leave the hospital setting.
Lucey notes that necessity or incentive typically spur changes such as this shift. However, he believes that the industry is feeling neither of these. While costs savings through ASC joint replacements or other outpatient procedures are a benefit to patients, commercial bundling and increased facility fees have intrigued payors enough to successfully make the move in select markets. Incentivizing payors to transition to ASCs can speed up the process and benefit all parties involved.
Finding the Right Patients
Lastly, moving away from a hospital setting means providers must thoroughly assess patients for potential risk factors. While not all patients are suitable for care outside of a hospital setting, implementing critical checks helps maintain high quality-of-care and patient safety standards. When providers assure patients that their safety and health are prioritized, they are more likely to trust care in an ASC setting.
The shift from HOPD to ASCs has been slow for joint replacement procedures. However, the reduced costs for patients, incentivized commercial bundles for payors, and more make the shift worthwhile.
Resources:
Becker’s: Outpatient vs Ambulatory Joint Replacement
SCA Health: Ambulatory Surgery Centers vs. Hospital Outpatient Departments
