20 flights of stairs, being discharged to home isn't going to happen,"
says Dr. Lee.
Willing insurers
One quick way to narrow down patients has nothing to do with
their overall health or attitude. "They've got to be under 65 typically,"
says Dr. Caillouette. "And that's because Medicare doesn't yet pay for
total joint procedures done in the outpatient setting."
In fact, one of the reasons same-day joint replacement isn't more
widespread is due to CMS's hesitance to reimburse the procedure. "It
can take a while for insurers to realize that they're saving money
because patients are out faster and return home," says Dr. Buch.
"There's been pushback against it, especially from Medicare, because
they want them to remain hospitalized for 2 days."
Private payers, though, are opening up to the idea of outpatient total
joints, thanks to its cost-savings and increased patient satisfaction.
Ms. White notes her center takes cash-paying patients and those using
their employers' domestic medical travel plans. The center has also
worked out contracts with several commercial HMO and PPO plans.
Ms. White points out that many big name national insurers are starting
to reimburse for same-day joints.
She says the key to promoting outpatient total joints to insurers is
being transparent about exactly how your costs, patient satisfaction
scores and complication rates compare to inpatient joint replace-
ments. That's usually enough to pique their interest.
OSM
E-mail kgapinski@outpatientsurgery.net.
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