Wednesday, May 23, 2018

Outpatient shoulder arthroplasty - surgeons' concerns about reimbursement.

Surgeons’ experience and perceived barriers with outpatient shoulder arthroplasty

These authors note that outpatient total shoulder arthroplasty (TSA) has been proposed as an alternative to the inpatient setting. They evaluated the expert shoulder surgeon’s experience with and perceived barriers to outpatient TSA.

They used a secure web application to perform an online survey of 484 active American Shoulder and Elbow Surgeons members. The survey assessed surgeon practice demographics, experience with TSA/outpatient TSA, and perceived barriers to successful outpatient TSA.

Of the 179 (37.0%) complete responses received, 20.7% perform outpatient TSA; of those, 78.4% reported an “excellent” experience. Outpatient surgeons were more likely to reside in the southern United States (P = .05) and performed a higher volume of TSAs annually (P = .03). Surgeons not performing outpatient TSA were more concerned with the potential of medical complications (P = .04). Perceived lack of experience (P = .002), low volume (P = .008), insurance contracts (P = .003), and reimbursement (P = .04) were less important barriers compared with outpatient TSA surgeons.

The authors note that as surgeons become more comfortable with outpatient TSA, there is a shift from concerns about medical complications to concerns about reimbursement.

Comment: There are many possible motivations for performing outpatient arthroplasty, including cost savings, patient convenience, marketing (Google "outpatient shoulder replacement"), surgeon ownership of an ambulatory operating facility, and other incentives. As physicians, our primary concern is the safety of the patient and the quality of the patient reported outcomes.  Further study is required to determine what patient characteristics, what surgeon experience, and what infrastructure elements are required to assure that the results of outpatient arthroplasty match those of inpatient arthroplasty. "Value" needs to be measured in terms of the benefit to the patient divided by the total cost of the procedure, including complications and readmissions.

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