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REGULATORY REVIEW


Driving Quality in ASC Total Joint Procedures Certifications, data collection and AJRR reporting are key BY ALEX TAIRA


As technology and new techniques expand the possibilities for outpa- tient surgery, few pro- cedures have been the


focus of as much discussion as total joint replacements (TJR). The rise of these procedures—in demand, performance and overall spend- ing—has been nothing short of meteoric. According to an October 2017 article in PubMed, “Outpatient Total Joint Arthroplasty,” between 2012 and 2015, elective TJR proce- dures, also called total joint arthro- plasty or TJA, went up 47 percent. New research presented this year at the 2018 Meeting of the American Academy of Orthopaedic Surgeons (AAOS) projected that the number of total hip replacements (THR) and total knee replacements (TKR) will grow by 171 percent and 189 per- cent respectively by 2030, according to a March 2018 AAOS release. The US already has the highest incidence rate of total knee arthroplasty (TKA) in the world, according to a Novem- ber 2017 PubMed article, “Projected Increase in Total Knee Arthroplasty in the United States—An Alternative Projection Model.” It is no surprise then that payers, both public and commercial, have taken intense interest in total joint procedures in recent years. In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced the Com- prehensive Care for Joint Replace- ment (CJR) reimbursement model, a new initiative by which Medicare would pay a single price for all related services in a 90-day period for TJRs, rather than reimbursing for each ser- vice separately. This model, called a “bundled payment,” seeks to incen-


The data accumulated in AJRR will allow stakeholders to compare ASC performance in TJR procedures across sites of service and, hopefully, show the growing role that ASCs play in meeting the increasing need for TJR procedures overall.”


—Alex Taira, ASCA


tivize physicians to manage resources and coordinate care with all providers involved in a TJR procedure, accord- ing to a July 2017 PubMed article, “Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.” This Medicare model was aimed at hos- pitals, but total joint procedures are by no means performed in hospitals only; many ASCs already perform total joint procedures, and with the aforementioned volume explosion on the horizon, it is clear that ASCs will play an enormous role in providing these services in the decades to come. This raises certain fundamental questions: How will the ASC commu- nity ensure that the high standards of


22 ASC FOCUS FEBRUARY 2019 | ascfocus.org


quality are upheld for these complex procedures? Will we see differentiated payer designs similar to CMS’ CJR model? How do we capture data to get the most accurate picture of volume and quality in a rapidly changing mar- ket? Several organizations, including commercial payers, accrediting orga- nizations and specialty registries have already begun the important task of answering these questions.


Rewarding Quality: Accreditation Certifications and Payer Designations A good place to begin would be with the accrediting organizations that already ensure that ASCs meet the regulatory and operational standards necessary to


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