eliminate the need for joint surgery, surgeons who specialize in
regenerative medicine are generating good revenues. There might
be a future role in the specialty for outpatient facilities, which
should consider establishing a formal pain management and
regenerative practice to position themselves for what could
evolve into a profitable service line.
• Expanding case volumes. Total joint replacements continue
to be one of outpatient surgery's hottest specialties. CMS has
removed knee replacement from its inpatient-only list, but still
won't pay for procedures performed on Medicare beneficiaries in
surgery centers (hip and shoulder replacements remain on the
inpatient-only list). We'll know if CMS will pay for knee replace-
ments performed in ASCs next year when Medicare's 2019 final
payment rule is released in November. I'm not overly hopeful. My
best guess is that CMS will finally reimburse for knees done in
ASCs beginning in 2021.
There's speculation about how many Medicare beneficiaries
who are in a surgeon's current stable of patients would be candi-
dates to have their joints replaced in an outpatient OR. Some
experts believe about 25% would qualify, but I think that's a high
estimate. Regardless of how many individuals older than 65 years
prove to be suitable candidates for outpatient joint replacement,
the number of cases performed in surgery centers will inevitably
increase when CMS finally green-lights the procedures. Facilities
with established programs in place, including relationships with
upstream and downstream providers who help to optimize pre-
and post-op care, will be positioned to capitalize on the expected
growth in case volume.
A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 9
