The Secret to Safe Outpatient Joint Replacement: The 79-Point Threshold
Exploring how the Outpatient Arthroplasty Risk Assessment (OARA) score boasts a 98.8% Positive Predictive Value for safe same-day discharge.
Over the last approximately 15 years, rapid recovery protocols focused on multidisciplinary care coordination, standardized perioperative protocols, and careful discharge planning have created a natural evolution from the inpatient to outpatient setting for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recently, this evolution was inadvertently accelerated as a result of confusion stemming from the removal of TKA from the inpatient-only list for Medicare patients by the Centers for Medicare and Medicaid Services Outpatient Prospective Payment System 2018 rule.
Combining the two-midnight rule and the removal of TKA from the inpatient-only list without defining justifying criteria for length of stay has inadvertently caused hospitals and payers to treat all Medicare TKA patients as outpatients, despite the intent of the Centers for Medicare and Medicaid Services that most Medicare TKA procedures would remain inpatient procedures.
