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 joint replacement,” 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 the 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.”
While this change in care process can be difficult at first, the value can be found in cost savings for patients and better financial outcomes for the physicians providing care.
To move out of a hospital setting, processes and systems need to be understood by those involved in providing care, creating 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 changes such as this shift are typically spurred by necessity or incentive, neither of which he feels are currently felt by those in the industry. While costs savings through ASCs 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 patients must be thoroughly assessed 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 patients are assured that their safety and health are prioritized, they are more likely to trust receiving care in an ASC setting.
While the shift from HOPD to ASCs has been slow for joint replacement procedures, the value offered through reduced costs for patients, incentivized commercial bundles for payors, and more make moving a large volume of procedures out of hospital settings worthwhile.