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. 


Outpatient Shift
Data Source: Stratasan's proprietary All-Payer Claims Dataset (for those under 65 years), In-Patient Standard Analytical Files, and Out-Patient Standard Analytic Files. For more executive-level commentary and insights from the week in healthcare from Gist Healthcare, subscribe to The Weekly Gist.

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