Orthopedic Surgery--Major Changes in Hospital Care and Payment
4.7 هزار بار بازدید -
2 سال پیش
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The Gist Newsletter and Stratasan
The Gist Newsletter and Stratasan have created an excellent analysis of the shift in knee replacements and hip replacements from the hospital inpatient setting to outpatient and ASCs.
Inpatient Total Knee Replacements have decreased from 100% to 25% between 2017 and today.
Inpatient Total Hip Replacements Have decreased from 100% to 37% from 2017 and today.
Meanwhile, Outpatient and ASC Total Knee and Total Hip Replacements have gone from 0% in 2017 to the VAST MAJORITY today.
Why? Why do so many fewer inpatient orthopedic surgeries happen?
1. CMS removed Knee Replacements from its Inpatient Only List in 2018. Prior to 2018, Medicare would only pay if the surgery was done in the inpatient setting.
Likewise, CMS removed Total Hip Replacements from its Inpatient Only List in 2019.
2. COVID--The Pandemic caused many hospitals to cancel their operating room schedules because of infection and staffing problems and as a result, orthopedic surgeons moved their surgeries to ASCs where the risk of cancelations is lower.
What are the Implications?
1. Employers win because ASCs generally have lower facility fees than hospitals, so their joint replacement unit costs will be lower.
2. Hospitals lose because lucrative commercially insured patients are now having their joint replacement surgeries outside of their hospital system.
3. For-profit hospital system Tenet is transitioning from being a 'hospital company' to being an ASC company and now runs 310 ASCs nationwide... more than any other organization. Tenet's ASC revenue went from 5% of its total revenue in 2015 to 42% of its total revenue in 2021--an almost 9X increase!
As this orthopedic example illustrates, change can be rapid in healthcare when the PAYMENT Changes.
Sources:
https://mailchi.mp/11f2d4aad100/the-w...
https://info.stratasan.com/gist
https://www.chartis.com/insights/medi...
https://www.healthcaredive.com/news/t...
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Inpatient Total Knee Replacements have decreased from 100% to 25% between 2017 and today.
Inpatient Total Hip Replacements Have decreased from 100% to 37% from 2017 and today.
Meanwhile, Outpatient and ASC Total Knee and Total Hip Replacements have gone from 0% in 2017 to the VAST MAJORITY today.
Why? Why do so many fewer inpatient orthopedic surgeries happen?
1. CMS removed Knee Replacements from its Inpatient Only List in 2018. Prior to 2018, Medicare would only pay if the surgery was done in the inpatient setting.
Likewise, CMS removed Total Hip Replacements from its Inpatient Only List in 2019.
2. COVID--The Pandemic caused many hospitals to cancel their operating room schedules because of infection and staffing problems and as a result, orthopedic surgeons moved their surgeries to ASCs where the risk of cancelations is lower.
What are the Implications?
1. Employers win because ASCs generally have lower facility fees than hospitals, so their joint replacement unit costs will be lower.
2. Hospitals lose because lucrative commercially insured patients are now having their joint replacement surgeries outside of their hospital system.
3. For-profit hospital system Tenet is transitioning from being a 'hospital company' to being an ASC company and now runs 310 ASCs nationwide... more than any other organization. Tenet's ASC revenue went from 5% of its total revenue in 2015 to 42% of its total revenue in 2021--an almost 9X increase!
As this orthopedic example illustrates, change can be rapid in healthcare when the PAYMENT Changes.
Sources:
https://mailchi.mp/11f2d4aad100/the-w...
https://info.stratasan.com/gist
https://www.chartis.com/insights/medi...
https://www.healthcaredive.com/news/t...
AHealthcareZ is 200+ Healthcare Finance Educational Videos.
💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca...
AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health.
90,000+ Views Per Month Across All Platforms.
Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.
2 سال پیش
در تاریخ 1401/05/22 منتشر شده
است.
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