Doctors in US divided over knee surgery for outpatients
FIVE years ago, Dr Ira K i r s c he nbaum, a n orthopedic surgeon in the Bronx who replaces more than 200 knees each year, would have considered it crazy to send a patient home the same day as a knee replacement operation.
And yet there he was this year, as the patient, home after a few hours. A physician friend pierced his skin at 8am at a Seattle-area surgery centre. By lunch, Kirschenbaum was resting at his friend’s home, with no pain and a new knee.
“I’m amazed at how well I’m doing,” Kirschenbaum, 59, said recently in a phone interview, nine weeks after the operation.
What felt to Kirschenbaum like a bold experiment may soon become far more standard. Medicare is contemplating whether it will help pay for knee replacement surgery outside the hospital.
The issue is sowing discord in the medical world, and the debate is as much about money as medicine. Some physicians are concerned that moving the surgery out of hospitals will land vulnerable patients in the emergency room with blood clots or other complications.
But proponents of t he change say it can give patients more choice and potentially better care, as well as save Medicare hundreds of millions of dollars. Already, an “overwhelming majority” of commenters said they want to allow the operations out of hospitals, according to recent rule-making documents.
The final decision would also act as a test of sorts for Donald Trump and his new administration. They will weigh whether to limit government controls, as Trump has often suggested, or to bend to pressure from hospitals and doctors.
“I think the question will come down to two things,” said David Muhlestein, senior director for research at Leavitt Partners, a leading health consulting firm. “It’s the balance of trying to reduce regulations and let the market function.”
Demand for total knee replacements is growing – 660,000 are performed each year in the US. That number is likely to jump to 2 million annually by 2030, making this operation one of surgery’s biggest potential growth markets.
Even if the policy change was made, Medicare would still pay for patients to get traditional inpatient surgery. But with the agency also paying for the bulk of outpatient procedures, there would be a huge shift in money out of hospitals. Medicare could save hundreds of millions of dollars if it no longer needed to pay for hospital stays. Investors at the outpatient centres could profit greatly, as could some surgeons, because doctors often have an ownership stake in the outpatient centres where they operate.