When Site-Of-Service Policy And Payment Reforms Converge: The Case Of Joint Replacement Surgery
Health Affairs February 3, 2020
Medicare continues to use large value-based payment models as a core strategy for increasing the value of lower extremity joint replacement surgery. Collectively, these models have engaged clinicians and organizations around the country in bundling total hip and knee replacement over the past five years, successfully reducing episode spending without apparent decrements in quality.
Separately, Medicare is moving away from historical precedent by loosening restrictions on performance of joint replacement at inpatient hospital sites only. As of January 1, 2018, total knee replacement has been removed from the “inpatient only” list and can therefore be performed as outpatient surgery at hospitals. Similar changes are being proposed for total hip replacement in 2020, along with related policies that would cover...