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It's no secret that there is an ongoing shift from inpatient to outpatient medical procedures. These days, patients prefer to have their knee replacement surgeries, cataract surgeries, colonoscopies, and mammograms (to name a few) performed in the outpatient setting due to the associated ease, convenience, and price point.
Complex procedures and surgeries are now possible in outpatient facilities due to (1) a consolidating market (2) CMS payment reforms and (3) new medical technologies like hybrid operating rooms and minimally invasive surgeries.
Let's take a closer look:
Over the past 10 years we've seen the healthcare market consolidate pretty significantly, particularly in the outpatient market. Hospitals, private equity firms, even insurers are quickly buying up outpatient facilities across the U.S. for several reasons:
Larger health systems and networks are also eager to acquire outpatient facilities because it helps keeps their patients in network and expands referral networks. And, many outpatient facilities also see these consolidations as mutually beneficial. With larger systems coming in to manage these smaller outpatient facilities, providers at outpatient facilities are freed up to do fewer administrative, financial operations, and reporting tasks and focus more on care delivery. The larger heath systems also expand outpatient budgets, which can result in shiny new equipment and technologies like EHR and telehealth systems.
Outpatient care may be growing in popularity, but it is only possible because of technological advancements:
ASCs are expected to receive a 2.1 percent increase in 2019 Medicare reimbursement on average per procedure. Similarly, hospital outpatient departments (HOPDs) will receive a 1.35 percent average rate increase in 2020.
Procedure codes continue to be added to CMS' payable/reimbursable list, which enables patients to seek more convenient care in surgery centers with the ease of mind to know that insurance covers the procedures. For instance, in 2018, CMS removed Total Knee Arthroplasty from its inpatient-only list. According to Definitive Healthcare data, the overall volume of TKA procedures increased by 8.14 percent from 2017 to 2018. So, in other words, as soon as this procedure was reimbursable in an outpatient setting patients started selecting these facilities for their procedures. Outpatient TKA market share increased by 88 percent in that time, and inpatient share decreased by 4.5 percent. Overwhelmingly, we are seeing a trend in an increase across the states. Texas had a 182 percent increase in TKA volume, followed by Kentucky at 144.7 percent, Illinois at 133.5 percent. Only Massachusetts, Rhode Island, Kansas, and Arkansas had a net decrease in outpatient TKA share from 2017 to 2018.
Want to stay abreast of the rapidly-consolidating U.S. outpatient market (clinics, ASCs, and imaging centers)? Interested in learning more about how payment reforms, technology advancement, and patient sentiment are driving change in the outpatient market? Definitive Healthcare's platform can help you: