Shifts in Care Setting: Knee and Hip Replacements by Payer, 2017-2021
Key Takeaways From Stratasan and Gist Healthcare (August 2022):
- Since 2017, high-volume orthopedic procedures, like knee and hip replacement, have gone from being almost entirely in-patient to majority out-patient/ASC.
- While these care-setting shifts can be attributed in part to COVID, the primary driver is CMS policy change.
- Q4 2021 data indicates whether patients move to OP or ASC is often determined by payer type. In-patient orthopedic procedures are the most Medicare-reliant, while ASCs are mostly commercial.
- A once-reliable revenue stream for hospitals and health systems is rapidly changing course. Acute-care providers must adapt to remain financially viable over the long term.
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