Robotics have been used in hospitals for years to perform esophageal, pancreatic and liver surgeries, and to perform bypass and transplant operations. Now, surgical robots are training their sights on a new frontier: the knee.
Robot-assisted knee surgeries have taken place en masse across the United States and around the world this summer and fall, with outcomes including faster recovery.
“This technology assists the surgeon in removing the diseased bone with great accuracy, while preserving important soft tissues and anatomical landmarks by creating a sterostatic boundary,” noted surgeon Dr. Robert J. Daley. “In my opinion, robotic-assisted surgery offers patients a more customized approach to total knee replacement surgery.”
Robots Can ‘Change the Game’
Robots have been used in partial knee replacement operations since the mid-2000s, but total knee replacement is different.
“This has the potential to change the game, which hasn’t happened in many years in knee replacement,” said one pioneering doctor in Buffalo, N.Y. “That’s because we’re saving soft tissue, there’s more personalized joint alignment and more precision.”
Part of that precision stems from how the surgery is carried out. Hospitals take a pre-op CAT scan of the patient, and the information is downloaded in the robot. “In the operating room, the robot syncs that data with the patient’s anatomy, essentially performing a virtual knee replacement before making any cuts,” the Panama City News Herald explained. “Not only does the (robot) provide the data and help make the cuts, but it also keeps the surgeons on track. If the cuts start to go too deep or the surgeon deviates from the operation’s blueprint, the machine will physically resist the surgeon, and will even shut itself down.”
One of the largest hospitals in San Antonio noted that doctors there perform several robot-assisted knee replacements a week.
While outcomes may be better, robot help comes with a price: robot-assisted surgery costs about twice as much traditional surgery, the American College of Surgeons found.
Changes Coming for Knee Surgery Reimbursement
Reimbursements for these and other services are set to see big changes thanks to rule changes proposed for the 2018 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System by the Centers for Medicare & Medicaid Services (CMS).
The new OPPS stretches 664 pages and the biggest change, according to industry watchers, is that CMS wants to take total knee replacements off the inpatient-only list. This has far-reaching implications for hospitals as hundreds of thousands of total knee arthroplasty operations are performed on Medicare patients each year.
The result would be more business for ambulatory surgical centers (ASCs). “For CY 2018, CMS is proposing to add three procedures to the ASC covered procedures list (CPL),” said the agency in its July 2017 announcement of the proposed changes to the OPPS. “In addition, CMS is soliciting comment on whether total knee arthroplasty, partial hip arthroplasty, and total hip arthroplasty meet the criteria to be added to the ASC-CPL.”
“For decades, hospitals have regarded inpatient surgical services as the key component for financial stability and revenue,” reported Healio. “The most lucrative part of surgical service lines is typically orthopedic care … The landscape for the future of surgical care, especially orthopedic care, will be disrupted by the removal of joint replacement procedures from the CMS inpatient-only list.”
Coders, orthopedic surgeons, billers, and office managers will want to stay current on other CPT code changes coming for orthopedics in 2018, as four code additions, nine code revisions, and seven code deletions are coming your way, notes Margie Scalley Vaught, an orthopedic coding and compliance specialist who presents for ProfEdOnDemand.
And more changes could be on the horizon: “CMS is also soliciting comments from stakeholders on whether there are codes outside of the AMA-CPT surgical code range that, nonetheless, should be considered to be a surgical procedure,” notes the agency, which is expected to release its final OPPS rule around November 1, 2017.
