On January 1, the Centers for Medicaid and Medicare Services (CMS) released changes made to its list of inpatient-only procedures. Currently, there are approximately 1,700 surgical procedures on the list, with some being added and removed every year. One of the most notable—as well as controversial—adjustments this year is the removal of total knee arthroplasty, or knee replacements, from the inpatient-only list. The procedure can now be performed in an outpatient or inpatient setting.
A major implication of this change is that ambulatory surgery centers (ASCs) and other outpatient care centers can offer this procedure, potentially drawing patients and revenue away from more traditional hospital inpatient departments. One factor driving patients to ASCs for procedures, especially knee and hip replacements, is the cost difference. Hip replacements at an outpatient surgery center cost between $22–25,000. The same procedure at a hospital is around $40,000. Currently hip replacements are not covered by Medicare in an inpatient setting. The effects of a shift like this can’t be accurately predicted yet, as hospitals and health systems have acquired or partnered with ASCs and outpatient centers in anticipation of such events.
The following list features the top 25 all-payer and Medicare inpatient procedures by volume, with ICD-9 and ICD-10 codes. Injections, transfusions, and diagnostic tests dominated both lists, with “Insertion of Infusion Device into Superior Vena Cava” (ICD-10 code 02HV33Z) taking the number 2 spot on each. X-rays (fluoroscopy) were also prevalent in the all-payer and Medicare procedure lists.