The Complex Case Conundrum With more complicated cases moving off the CMS inpatient-only case list, should ASCs add these procedures to their mix? BY LINDSAY MCQUEENEY HANRAHAN

Thanks to advances in technology, many histori- cally complex orthopedic and spine procedures have become much less inva-

sive. As a result, many of these cases are now well-suited for outpatient environments, especially ASCs, which have a strong track record of afford- able, quality care and positive patient outcomes. An accumulation of data now exists that shows top-quality out- comes, high patient satisfaction levels and substantial cost savings when total joint replacement procedures are per- formed in ASCs. With data in hand, the ASC indus-

try has been pushing for more com- plex cases to come off the Centers for Medicare & Medicaid Services (CMS) inpatient-only case list. On November 2, 2016, CMS released its 2017 final rule, which includes the removal of seven procedures from the inpatient-only list. Their removal from that list represents significant progress for the ASC industry. CMS also is considering recommendations from the US Department of Health and Human Services’ (HHS) advisory panel on the possible removal of total knee arthroplasty from CMS’ inpa- tient-only list.

Making the Case Populations are changing. People are staying healthy and active longer. They also are more willing to pursue a complex procedure at a younger age due to the less invasive nature of the procedure. These population changes, coupled with advances in technology that have made proce-


dures shorter, less invasive and less risky, mean there are fewer reasons to keep these cases on the “hospital- only” list. Since ASCs continue to be reim-

bursed at a lower rate, there also are significant financial benefits asso- ciated with performing historically inpatient-only cases in ASCs. ASCs in the US save commercial insurers and their beneficiaries more than $38 bil- lion per year, according to a Health- care Bluebook study that used data supplied by HealthStream. Allowing total knee and total hip replacements to be performed at ASCs could result in an additional savings of $3.2 billion to private payers and their patients, according that study.

ASC Considerations

The benefits of adding these new pro- cedures to an ASC’s case list are plenty. Because these procedures are highly valued, they have the potential to bring in additional revenue. Furthermore, the procedures provide an opportunity for ASCs to become leaders in their communities by offering more com- plex services. As new procedures are removed from the Medicare inpatient-only list, ASCs around the country are likely contemplating adding them to their case list. While there are some real benefits associated with taking on these traditionally complex proce- dures, they are not right for every cen- ter. It is a center-specific decision that

The advice and opinions expressed in this column are those of the author’s and do not represent official Ambulatory Surgery Center Association policy or opinion.

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30