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The Shift to Outpatient Large-Joint Replacement Surgeries

The Shift to Outpatient Large-Joint Replacement Surgeries

Less invasive techniques, better pain management, pressure to minimize costs, and changing reimbursement rules are leading to interesting shifts in the large-joint market. MedTech Senior Analyst Mohith Unny discusses these shifts and what we can expect to see in the future.



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Video transcript:

Q1. What’s driving the shift towards more outpatient large-joint replacement procedures?
Most large-joint replacements, especially those for the hip as well as total knee replacements, have traditionally been performed largely in inpatient settings. However, with advancements in minimally invasive surgical techniques and pain management, as well as patient demand for high quality low cost treatments, more of these procedures are now performed in hospital outpatient settings and ASCs, especially for younger and healthier patients. The proportion of surgeries such as unicondylar knee and patella-femoral knee replacements, which are fairly easy to perform, has already seen a drastic decline in inpatient settings. Around 50% of these surgeries are now being conducted in hospital outpatient departments and ASCs. Total knee replacements, however, which make up around 80% of all knee replacement surgeries, are still mostly performed in inpatient settings. That’s likely to change because the CMS has removed TKA surgeries from its inpatient-only list in January 2018. So we believe that more and more TKA surgeries would now be performed in outpatient settings. No decision has been taken for hip replacements yet so the shift to outpatient settings will likely be slower on that front.

Q2. What can we expect to see in the future?
Though the CMS has not yet approved reimbursement for TKA surgeries in ASCs, we believe that it won’t be long before it does receive approval. The CMS is also likely to take a call on offering coverage for outpatient hip replacements as well as shoulder and ankle replacements. Given these factors, we predict that around 25-30% of all large-joint replacements will be performed on an outpatient basis in the next 10 years, with those for the knee being a bit over 40%.

Q3. How is DRG Medtech helping our clients?
DRG’s M360 insights report for Large-Joint reconstructive implants now offers 10-year site of service procedure volume forecasts for both knee and hip replacements. Our Procedure Finder product can help clients with data on site of service splits at procedure-code level while our PriceTrack product offers SKU-level pricing data at facility-level as well as brand market shares for knee and hip implants.