Pandemic hampers reopening of joint replacement gold mine

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by Bernard J. Wolfson, Kaiser Health News

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Credit: Pixabay/CC0 Public Domain

Dr. Ira Weintraub, a lately retired orthopedic surgeon who now works at a medical billing consultancy, noticed a hip replacement invoice for over $400,000 earlier this 12 months.

                                                                            <p>"The patient stayed in the <a href="https://medicalxpress.com/tags/hospital/" rel="tag" class="textTag">hospital</a> 17 days, which is only 17 times normal. The bill got paid," mused Weintraub, chief medical officer of Portland, Oregon-based WellRithms, which helps self-funded employers and staff' compensation insurers make sense of giant, complicated medical payments and guarantee they pay the honest quantity.

Charges like that go a good distance towards explaining why hospitals are keen to revive joint replacements to pre-COVID-19 ranges as rapidly as attainable—an eagerness tempered solely by security considerations amid a resurgence of the coronavirus in some areas of the nation. Revenue losses at hospitals and outpatient facilities might have exceeded $5 billion from canceled knee and hip replacements alone throughout a roughly two-month hiatus on elective procedures earlier this 12 months.

The price of joint replacement surgical procedure varies extensively—although, on common, it’s within the tens, not tons of, of 1000’s of {dollars}. Still, given the excessive and quickly rising quantity, it is easy to see why joint replacement operations have grow to be an important chunk of income at most U.S. hospitals.

The fee of knee and hip replacements greater than doubled from 2000 to 2015, in keeping with inpatient discharge information from the Agency for Healthcare Research and Quality. And that development is more likely to proceed: Knee replacements are anticipated to triple between now and 2040, with hip replacements not far behind, in keeping with projections printed final 12 months within the Journal of Rheumatology.

Joint procedures are normally not emergencies, they usually have been among the many first to be scrubbed or delayed when hospitals froze elective surgical procedures in March—and once more in July in some areas suffering from renewed COVID-19 outbreaks. Loss of the income has hit hospitals onerous, and regaining it will likely be essential to their monetary convalescence.

“Without orthopedic volumes returning to something near their pre-pandemic levels, it will make it difficult for to get back to anywhere near break-even from a bottom-line perspective,” stated Stephen Thome, a principal in well being care consulting at Grant Thornton, an advisory, audit and tax agency.

It’s unimaginable to know precisely how a lot knee and hip replacements are price to hospitals, as a result of no definitive information on complete quantity or value exists.

But utilizing printed estimates of quantity, extrapolating common industrial funds from printed Medicare charges primarily based on a examine, and making an informed guess of affected person coinsurance, Thome helped KHN arrive at an annual market worth for American hospitals and surgical procedure facilities of between $15.5 billion and $21.5 billion for knee replacements alone.

That suggests a income loss of $1.three billion to $1.eight billion monthly for the interval the surgical procedures have been shut down. These figures embrace ambulatory surgical procedure facilities not owned by hospitals, which additionally suspended most operations in late March, all of April and into May.

If you add hip replacements, which account for about half the quantity of knees and are paid at comparable charges, the whole annual worth rises to a variety of $23 billion to $32 billion, with month-to-month from $1.9 billion to $2.7 billion.

The American Hospital Association tasks complete income misplaced at U.S. hospitals will attain $323 billion by 12 months’s finish, not counting extra losses from surgical procedures canceled in the course of the present coronavirus spike. That quantity is partially offset by $69 billion in federal reduction {dollars} hospitals have obtained thus far, in keeping with the affiliation. The California Hospital Association places the online income loss for hospitals in that state at about $10.5 billion, stated spokesperson Jan Emerson-Shea.

Hospitals resumed joint replacement surgical procedures in early to mid-May, with the timing and ramp-up velocity various by area and hospital. Some hospitals restored quantity rapidly; others took a extra cautious route and proceed to lose income. Still others have needed to shut down once more.

At the NYU Langone Orthopedic Hospital in New York City, “people are starting to come in and you see the operating rooms full again,” stated Dr. Claudette Lajam, chief orthopedic security officer.

At St. Jude Medical Center in Fullerton, California, the place the coronavirus is raging, inpatient joint replacements resumed within the second or third week of May—cautiously at first, however quantity is “very close to pre-pandemic levels at this point,” stated Dr. Kevin Khajavi, chairman of the hospital’s orthopedic surgical procedure division. However, “we are constantly monitoring the situation to determine if we have to scale back once again,” he stated.

In giant swaths of Texas, elective surgical procedures have been as soon as once more suspended in July as a result of of the COVID-19 resurgence. The identical is true at many hospitals in Florida, Alabama, South Carolina and Nevada.

The Mayo Clinic in Phoenix suspended nonemergency surgical procedures in early July. It resumed outpatient replacement procedures the week of July 27, however nonetheless has not resumed nonemergency inpatient procedures, stated Dr. Mark Spangehl, an there. In phrases of medical urgency, joint replacements are “at the bottom of the totem pole,” Spangehl stated.

In phrases of money movement, nevertheless, joint replacements are decidedly not on the backside of the totem pole. They have grow to be a money cow because the quantity of sufferers present process them has skyrocketed in current many years.

The quantity is being pushed by an growing older inhabitants, an epidemic of weight problems and a major rise within the quantity of youthful individuals changing joints worn out by years of sports activities and train.

It’s additionally being pushed by the money. Once solely performed in hospitals, the operations are actually more and more carried out at ambulatory surgical procedure facilities—particularly on youthful, more healthy sufferers who do not require hospitalization.

The surgical procedure facilities are sometimes physician-owned, however non-public fairness teams similar to Bain Capital and KKR & Co. have taken an curiosity in them, drawn by their excessive development potential, strong monetary returns and skill to supply aggressive costs.

“(G)enerally the savings should be very good—but I do see a lot of outlier surgery centers where they are charging exorbitant amounts of money – $100,000 wouldn’t be too much,” stated WellRithms’ Weintraub, who co-owned such a surgical procedure heart in Portland.

Fear of catching the coronavirus in a hospital is reinforcing the outpatient development. Matthew Davis, a 58-year-old resident of Washington, D.C., was scheduled for a hip replacement on March 30 however acquired chilly toes as a result of of COVID-19, and canceled simply earlier than all elective surgical procedures have been halted. When it got here time to reschedule in June, he overcame his reservations largely as a result of the surgeon deliberate to carry out the process at a free-standing surgical procedure heart.

“That was key to me—avoiding an overnight hospital stay to minimize my exposure,” Davis stated. “These joint replacements are almost industrial-scale. They are cranking out joint replacements 9-to-5. I went in at 6:30 a.m. and I was walking out the door at 11:30.”

Acutely conscious of the monetary advantages, hospitals and surgical procedure clinics have been advertising and marketing joint replacements for years, competing for coveted rankings and working adverts that present wholesome growing older individuals, all smiles, engaged in vigorous exercise.

However, a 2014 examine concluded that one-third of knee replacements weren’t warranted, primarily as a result of the signs of the sufferers weren’t extreme sufficient to justify the procedures.

“The whole marketing of health care is so manipulative to the consuming public,” stated Lisa McGiffert, a longtime shopper advocate and co-founder of the Patient Safety Action Network. “People might be encouraged to get a knee replacement, when in reality something less invasive could have improved their condition.”

McGiffert recounted a dialog with an orthopedic surgeon in Washington state who informed her a couple of affected person who requested a knee , despite the fact that he had not tried any lower-impact therapies to repair the issue. “I asked the surgeon, ‘You didn’t do it, did you?’ And he said, ‘Of course I did. He would just have gone to somebody else.'”


It may take up to a year to get through elective surgeries due to COVID-19

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                                            ©2020 Kaiser Health News<br/>Distributed by Tribune Content Agency, LLC.


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