total knee replacement - memberclicks · 2018-03-02 · transitioning total joints to outpatient...
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Total Knee ReplacementOutpatient Surgery
Abraham Abdo, MD Orthopedic Surgery2698 N. Galloway AveMesquite, TX 75150
Modern Era of Total Knee Arthroplasty
began with Gunston in 1971
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Many of the problems encountered with early designs
have been defined and appropriate solutions have been
identified.
New designs took into consideration problems with
• Patellofemoral pain• Alignment• Tracking • Polyethylene wear• Instrumentation
Arthritis affects about 40 million Americans, 1 in 8 people.
700,000 TKA are performed annually.
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Painful Arthritic Knee Joint that failed to respond to conservative therapy that includes:
•Medications
• Physical Therapy
•Modification of Activities
• Injections• Arthroscopy
Surgical Procedure
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Past 20 years duration of hospitalization for TKA in U.S. has
decreased from 9 to 4 days.
The hospital cost for TKR has increased. Therefore, reduction in length of stay remains an important target for cost
containment.
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Pain management and anesthesia advancement has played a big role in transitioning total joints to outpatient
setting.
Projected Outpatient Surgery for Joint Replacement• 2016: 15%
• 2018: 25%
• 2020: 32%
• 2022: 37%
• 2024: 43%
• 2026: 51% 0
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2016 2018 2020 2022 2024 2026
Beginning of 2018, CMS removed Total Knee Replacement from the inpatient only list.
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•Reimbursement rate of $12,384 for inpatient and $10,122 for outpatient surgery would result in 18% decrease in reimbursement for providers.•A saving of $311 million for Medicare.
Pathway to Outpatient TKR
•Preoperative Screening‐ comorbidities
•Patient Education & Expectation Alignment•Pain Management & Early Mobilization•Minimization of Blood Loss
ASA Class 1‐3BMI 35 or less
Age 70 years old or younger
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Inpatient Certification• High Risk for DVT
HX A FIB
Mechanical Heart Valve
HX VTE in past 3 months
• One or more of the following comorbidities:
DM, BMI>35, Cardiac: CAD, HF, AMI
COPD, Sleep Apnea, Dementia, Falls
10.2 % of outpatient TKR procedures were readmitted within 30 days
Compared to 6.6% of the inpatient procedure group.
• Will our patient want this?
• Are the physicians on board?• Are the facilities appropriate?• Limitations of the staff?
• How will we select patients?• What will happen before, during, and after?
• Are we confident in our value proposition and minimum reimbursement rates?
• Marketing?
• Evaluate our successes and failures.