August is National Ambulatory Surgery Center (ASC) Month and the American Joint Replacement Registry (AJRR) has invited Alex Taira, Policy Analyst, Ambulatory Surgery Center Association (ASCA), to contribute a guest blog on the evolution and diversity of today’s orthopaedic surgery sites. It has always been the American Academy of Orthopaedic Surgeons’ (AAOS) belief that choosing the appropriate orthopaedic surgery setting is a decision that the patient and the surgeon make together based on a series of factors that lead to the best patient experience and outcome. Today’s patient options include hospitals, hospital-sponsored ASCs, and independent ASCs.

Over 1,000 U.S. hospitals and 68 ASCs participate in AJRR. Based on the number of procedures submitted monthly, AJRR is the largest orthopaedic registry in the world. The AJRR database holds 1.3 million hip and knee arthroplasty procedures from over 8,000 surgeons practicing in one or more types of clinical settings. As more total joint arthroplasties (TJAs) are performed in ASCs, reducing variation and demonstrating quality of care delivered can be accomplished through Registry participation.

Guest Blogger: Alex Taira Talks About ASCA, AJRR, and the Orthopaedic Surgery Market  

In 2017, AJRR and ASCA announced a collaborative relationship, aimed at encouraging ASCA-member ambulatory surgery centers to register in the AJRR. William Prentice, ASCA CEO, announced the new venture with enthusiasm saying, “The data collected by the AJRR will be used by ASCA and our members to support efforts to educate government and commercial payors of the safety, efficiency, and good outcomes that result when ASCs perform these procedures.” As the discussion around value-based reimbursement for total joint procedures in ASCs increases in intensity, AJRR will undoubtedly play a vital role in validating ASCs as a high quality site of service.

The size of the entire orthopaedic surgery market continues to grow, challenging providers to service larger volumes of patients. By 2060, primary total hip replacement (THR) is expected to reach 1.23 million (330 percent increase), primary total knee replacement (TKR) is expected to reach 2.60 million (382 percent increase), revision THR is expected to reach 110,000 (219 percent increase), and revision TKR is expected to reach 253,000 (400 percent increase)*.

Orthopaedics represents a significant portion of procedures done in ASCs and the procedural volume of ASCA members continues to grow along with the market. For example, of 126 discrete surgical procedures that appeared in the Top 100 Medicare codes by volume in ASCs (2010-2016), 22 codes were orthopaedic related. As technology has progressed, it enabled these procedures to move to outpatient settings. It is likely that orthopaedic treatment will only grow in importance to ASCs as total joint procedures become eligible for Medicare reimbursement in the future.

As more TJAs continue to migrate from the inpatient setting, either to hospital sponsored or independent ASCs, it is important that AJRR continue to capture these procedures. Further, as the AAOS Registry Program expands to include other anatomical areas including shoulder, elbow, and especially rotator cuff surgical procedures; increasing partnerships with ASCs will be necessary to provide a true picture of the marketplace.

Nathan Glusenkamp, MA, Director of Registries, AAOS, recently said, “If more ASCs participate in AJRR, we can first, begin to run ASC-specific analyses from presentation and second, begin to provide like-institutional comparisons.” ASCA agrees that registry participation benefits institutional subscribers and patients alike. ASCA and AAOS will continue their collaboration to help measure and ensure demonstrably safe, high quality outpatient orthopaedic procedures in the ASC space.

*Matthew Sloan, MD, lead author of research paper submitted to the March 2018 AAOS Annual Meeting (3/6/2018).

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