Imagine this: get knee replacement surgery in the morning, and be home in time for dinner. In pain and on a walker, perhaps, but home nonetheless.
That’s the future that awaits otherwise healthy patients, according to orthopedic surgeon Daniel Goldstein. That’s the future that Medicare may make possible. And Einstein Medical Center Montgomery, where Dr. Goldstein works—with its on-site surgical center and affiliation with MossRehab—is the ideal setting for outpatient knee surgery.
“We’re doing knee replacements in younger and healthier patients and we decided that some of them don’t have to stay overnight or two or three nights,” he said. A patient who is otherwise healthy, is walking, has a companion at home to help, and can tolerate the pain, is the ideal candidate for the outpatient procedure.
Dr. Goldstein acknowledges that support of outpatient knee replacement is not universal among orthopedists, who worry about patient safety. But he thinks going home is a good option. “The sooner we can get you out of the hospital, the more we can try to limit the complications of being in the hospital,” he said.
The controversy over outpatient knee replacement surgery intensified last summer, when a policy panel recommended Medicare stop mandating knee replacement be done as an inpatient to qualify for reimbursement. The change is under consideration. Knee and hip replacement are the most common types of surgery for patients on Medicare; more than 400,000 Medicare beneficiaries had knee or hip replacement surgery in 2014, according to federal statistics.
In addition to concerns about patient safety, there are major financial implications to a change in policy. Hospitals could potentially lose money if the lucrative surgery is performed in outpatient surgical centers. And patients could potentially lose Medicare coverage for rehab and other aftercare.
“We’re now in the figuring-it-out stage on multiple fronts,” including finances, Dr. Goldstein said. The next step is to set up a steering committee to explore the issue. If the hospital decides to move forward, he said, Einstein Montgomery is an ideal location: a surgery center is on site and a patient could be transferred to the hospital in the event of complications. And MossRehab is part of the Einstein network and could seamlessly provide physical therapy, he said.
“It’s a big stepping block that we’re going to have to get involved with,” Dr. Goldstein said. “The sooner we get this going, the better.”