Aug 1, 2019

Medicare proposes outpatient hip replacements

Hip Prosthesis, Surgery X-rays (Photo by: BSIP/Universal Images Group via Getty Images)

Hip Prosthesis, Surgery X-rays. Photo: BSIP/Universal Images Group via Getty Images

Medicare is proposing to start paying for total hip replacement surgeries in outpatient surgery centers next year, meaning patients can go home the same day they get the procedure instead of having to stay overnight in a hospital.

Why it matters: Medicare spent roughly $6.5 billion on hospitalizations tied to hip and knee replacements in 2016. There’s a push to move more of those costly procedures into surgery centers because patients could recover at home and it’s cheaper to do as an outpatient.

Between the lines: Many patients with commercial insurance get new hips and knees in surgery centers instead of hospitals. Medicare started allowing knee replacements to occur in outpatient centers in 2018, and officials have contemplated doing the same with hip replacements since then — so this was just a matter of time.

  • Hospitals aren’t thrilled about this shift because these surgeries are more lucrative in the inpatient setting. 
  • There’s also concern about whether Medicare patients, who usually are older and more frail, need extra recovery time before going home.

Yes, but: Surgery centers and orthopedic surgeons naturally love this because they’ll get a ton of new Medicare patients, and the revenue that comes along with it.

  • And hospitals have been hedging this trend for years by acquiring orthopedic surgery centers and physician groups.

Go deeper: Hospital joint replacement prices are all over the board

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