57% of Total Inpatient Joint Replacement Surgeries Could be Shifted to Outpatient Procedures in 2018
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By: Saparja Nag Dec. 04, 2017
An analysis by Dexur estimates that 57.5% of joint replacement surgeries are total knee arthroplasty (TKA) cases that could be shifted to outpatient procedures under new CMS guidelines. Effective on January 1, 2018, TKA will be removed from the inpatient only list (IPO) as announced by the Department of Health and Human Services on November 13, 2017. TKA consists of DRG-469: major joint replacement or reattachment of lower extremity with MCC and DRG-470: major joint replacement or reattachment of lower extremity without MCC. The below table & chart based on the most recently available data from Medicare shows how many TKA procedures could be potentially shifted to outpatient.
| Total CMS Medicare FFS Discharges (Jan to Dec 2016) | Total TKA Eligible Discharges (Jan to Dec 2016) | % of TKA Discharges potentially shifting to Outpatient | |
|---|---|---|---|
| DRG 470 | 519,701 | 307,886 | 59.2% |
| DRG 469 | 27,239 | 6,843 | 25% |
| DRG 470 + DRG 469 | 546,940 | 314,729 | 57.5% |
There were a number of factors involved in the decision to remove TKA from IPO including cost and patient outcomes. The most significant of these reasons was modern techniques that have made TKA a safe procedure that can be performed on Medicare patients in an outpatient setting. Certain facilities have been performing outpatient TKAs on non-Medicare patients as well, supporting the safety of the procedures. Peer-reviewed publications have also discovered that TKA outpatient surgeries did not have higher rates of readmission or complications than those who underwent TKA as an inpatient procedure. Healthcare providers will now be required to adequately screen patients who are appropriate candidates for outpatient TKA procedures by developing evidence-based selection criteria for qualified patients.
The below table outlines the potential impact of TKA surgeries moving to outpatient for the top 10 hospitals by DRG-470 and DRG-469 Medicare discharge volume for January to December 2016. It is not surprising that HSS in New York is the largest in the country for joint replacement surgeries and also has the highest number of TKA eligible cases at 55% of all cases. The next largest is New England Baptist Hospital in Roxbury Crossing, MA where 56% of all joint replacement surgeries and 47% of all orthopedic surgeries may move to the outpatient area.
| Hospital Name | Total Orthopedic Surgical Discharges | Total DRG 469 + 470 Discharges | Total TKA Eligible Discharges (DRG 470 + 469) | % of DRG 470 & 469 | % of Orthopedic Surgical Discharges |
|---|---|---|---|---|---|
| National | 981,001 | 546,940 | 314,729 | 57.5% | 32.1% |
| Hospital For Special Surgery (HSS), New York, NY | 5,481 | 4,062 | 2,215 | 55% | 40% |
| New England Baptist Hospital, Roxbury Crossing, MA | 2,745 | 2,286 | 1,290 | 56% | 47% |
| Mayo Clinic Hospital, Rochester, MN | 3,042 | 1,530 | 830 | 54% | 27% |
| Christiana Care, Wilmington, DE | 2,480 | 1,495 | 926 | 62% | 37% |
| Beaumont Hospital, Royal Oak, MI | 2,625 | 1,481 | 844 | 57% | 32% |
| Virtua West Jersey Health. Voorhees, NJ | 1,854 | 1,443 | 1,047 | 73% | 56% |
| Northshore University Healthsystem, Evanston, IL | 2,024 | 1,412 | 786 | 56% | 39% |
| Hoag Orthopedic Institute, Irvine, CA | 1,813 | 1,367 | 725 | 53% | 40% |
| Swedish Health Services, Seattle, WA | 2,007 | 1,341 | 732 | 55% | 36% |
| Christ Hospital, Cincinnati, OH | 1,629 | 1,289 | 812 | 63% | 50% |
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