Is Ambulatory/Outpatient Joint Surgery Covered by Medicare?
Total knee and total hip replacement surgeries at Ambulatory Surgical Centers (ASCs) are eligible for payment
Ambulatory surgeries offer numerous advantages to patients and their medical providers. Access to ambulatory hip and knee joint replacement surgery is lower for the Medicare population than for other patient segments. One reason is simply the lack of awareness due to the frequently changing rules governing Medicare. As of 2021, total knee and total hip replacement surgeries at ambulatory surgical centers (ASCs) are now covered by Medicare. This was an important milestone since 85% of the UNOVA patient population base is of Medicare age.
The surgeons at UNOVA Hip & Knee Center have been performing outpatient joint replacement surgery since 2006 and ambulatory joint replacement surgery since 2008, longer than the majority of orthopedic surgeons in the country. Early on they recognized the benefits. To not only their patients and the payers but also to the providers. Let’s dig in a bit more:
What is the difference between outpatient and ambulatory surgery?
Outpatient surgery is defined as a surgical process that is designed to allow the patient to be discharged home within 48 hours of the completion of a surgical procedure. Ambulatory surgery, on the other hand, is a surgical process that is designed to allow the patient to be discharged from the ASC within a few hours of the completion of the surgical procedure. Because of advances in pain control, blood loss management, tissue-sparing approaches to the hip and knee, as well as improvements in implant materials in general, surgeries performed on an outpatient basis have fewer risks of complications. Early mobilization leads to lower incidences of pneumonia and blood clots. Tissue-sparing approaches and procedures lead to lower reliance on opioid and narcotic use for pain management nearly eliminating the occurrence of post-operative falls during recovery. The surgeons at UNOVA Hip & Knee Center are nationally recognized experts in ambulatory hip and knee replacement surgery, as such, on average their patients walk out of the ASC less than two hours after completion of their surgery.
What are the benefits of outpatient and ambulatory surgery?
Outpatient and ambulatory hip and knee replacement surgery relies on a team approach to care with a coordinated care delivery process that spans the patient’s pre, peri and post-operative course. The team is made up of surgeons, medical doctors, nurse practitioners, pas, surgical staff, home health nurses, and physical therapists. Benefits of this coordinated delivery system include:
Recovery at home: studies have shown that patient recover faster and with less sleep disruption and confusion when they recover at home.
Lower rate of surgical site and other infections: Recovering at home, in general, leads to less disruption of the surgical bandage and lower exposure to bacterial load than in a hospital setting.
Greater efficiency in delivery of care: Because your surgeon has greater control over the delivery of your care in the outpatient or ambulatory setting, care delivery is not only more efficient, but produces less waste, and again, significant cost reductions in care.
Less out-of-pocket cost for patients: According to a study from Becker’s ASC Review, the average cost of ASCs was 40% less than the hospital group. Since the cost of ambulatory and/or outpatient surgery is 40% lower than that of inpatient surgery, out-of-pocket patient costs are lower, and removing cost from the episode of care increases the value of these procedures being done in the ambulatory or outpatient setting.
As a patient on Medicare, is outpatient surgery right for me?
Every medical decision should be patient-driven, and the best approach for one patient may not work for another. Individualized care designed around each patient’s needs is critical to a sustainable, efficient health system. Click here to learn how to choose an orthopedic surgeon.
At UNOVA Hip & Knee Center, we see the relief and freedom people experience when they regain mobility, strength, and flexibility after outpatient joint replacement surgeries. To learn more about your surgery options, reach out to us at 312-973-4070.
