Should CMS do step-wise introduction of outpatient procedures for Medicare patients, allowing the procedures to be done at a hospital outpatient department and if deemed safe, clearing them to then be done at an ASC?

Orthopedics Today—October 7, 2017

In a counter article by Orthopedics Today, HSS chief value medical officer Catherine H. MacLean, MD, PhD provided commentary on the question of should outpatient procedures for Medicare patients be done at an ASC.

Dr. MacLean cautioned that ambulatory total knee arthroplasty (TKA) is not safe for those with significant medical comorbidities and/or limited home support, i.e. most Medicare beneficiaries. She added that patients with a low risk of complications could be safely treated in an ambulatory setting, but there isn’t a reliable method to identify these patients.

"At the very least, ambulatory TKA will require some level of home health services coordinated with the treating facility to ensure safety," Dr. MacLean wrote.

Dr. MacLean proposed to remove TKA from the 'inpatient-only' list only for facilities participating in the Comprehensive Care for Joint Replacement program. She noted that these facilities have already put into place care structures and processes to monitor patients post-discharge. Additionally, she wrote that patients who do develop complications after discharge are more likely to be identified in a timely manner.

Read the full article at healio.com [registration required]. This article appeared in the October 2017 print issue.