Joint Replacement and Outpatient Surgery
Joint Replacement and Outpatient Surgery

joint and kneeFor years CMS has encouraged, indeed motivated, Hospitals and Health Systems to migrate as much as possible from the inpatient setting to the Outpatient one. Now there is a revolution in which physicians/Surgeons either in conjunction with a hospital or independently opened very successful Outpatient Surgery Centers, thus taking much revenue away from the Hospitals.

There is a newer Outpatient Surgery delivery model that has been patient driven, by patients who don’t want or need an inpatient stay and don’t want to because of cost and time away from life, work and family. The new model is focused on joint replacements, procedures that have been the bread and butter of hospitals. There is evidence that such procedures done on an outpatient basis cost half as much. But in those facilities where it is performed, staff are more motivated to be efficient with the kinds of things that make the inpatient arena seem old and tired. There are many arguments about patient safety and indeed not everyone can have an outpatient procedure. But those in operation owned partially or entirely by physicians have become very effective in turnover of procedure room and effective transition of patients to home.

There is a huge problem and that is reimbursement. But as CMS begins to examine the data regarding costs, morbidity and patient satisfaction, it will begin to follow its philosophy: “It’s the Peoples Money” spend it carefully and frugally and provide quality.

Among our client hospitals a number has decided to look at the data regarding volumes, morbidity, costs and reimbursement. This requires carefully reviewing cases, making sure that the data are correct in terms of Coding, claims management and accuracy especially in light the precision required in the ICD 10 world.

Our firm HSMN (Health Systems Management Network) has been working with hospitals and Outpatient Centers for thirty years (30) and data analysis confirmed by going to source records to assure accuracy has been our signature. Many years ago, one of the most successful, innovative and famous Orthopedic Hospitals turned to our firm to look at the data regarding the length of stay and cost of admissions. Even then we had an idea that the Outpatient was going to be the major arena for all kinds of procedures.

Now we are in a new season: CMS wants more for its spending and because of that fact hey have an eye on the Outpatient either affiliated or independent Outpatient Surgery Centers. Now is the time to put in place a way of capturing data and assuring its accuracy because future reimbursement will depend on it. After 30 years and working with every clinical discipline, our firm is ready to help. Please do not hesitate to contact us.