A Cautionary Tale: Malaligned Incentives in Total Hip and Knee Arthroplasty Payment Model Reforms Threaten Promising Innovation and Access to Care.

Over the past several years, there have been notable changes and controversies involving Medicare reimbursement for total hip (THA) and total knee arthroplasty (TKA). We have seen the development and implementation of experimental bundled payment model pilot programs goals of improving quality and decreasing overall costs of care during the last decade. Many orthopaedic surgeons have embraced these programs and have demonstrated the ability to succeed in these new models by implementing strategies, such as preservice optimization, to shift care away from inpatient or postdischarge settings and reduce postoperative complications.

Health Policy Views and Political Advocacy of Arthroplasty Surgeons: A Survey of the American Association of Hip and Knee Surgeons Members.

Background: The American Association of Hip and Knee Surgeons (AAHKS) is the largest specialty society for arthroplasty surgeons in the United States and is dedicated to education, research, and advocacy. The purpose of this study was to identify the health policy views of AAHKS members and better characterize their advocacy participation.

Methods: A 22 question survey was electronically distributed multiple times via email link to all 3,638 United States members of AAHKS who were in practice or training in 2022.

Arthroplasty During COVID-19: Surveillance of AAHKS Members in the First Year of the Pandemic.

Background: The COVID-19 pandemic has had a severe impact on the practices of adult reconstruction surgeons, primarily due to the elective nature of hip and knee arthroplasty.

Methods: To capture the impact of COVID-19 on its members, the American Association of Hip and Knee Surgeons sent 6 surveys over a span of 7 months from late March until September of 2020 querying its members regarding the effects of COVID on the health and well-being of their personal, financial, and clinical practice.

Results: Ninety-two percent of surgeons reported a cessation of elective inpatient cases during the height of the crisis.

The Removal of Total Hip and Total Knee Arthroplasty From the Inpatient-Only List Increases the Administrative Burden of Surgeons and Continues to Cause Confusion.

Background: Several studies have shown that the removal of total knee arthroplasty (TKA) from the Centers for Medicare and Medicaid Services (CMS) inpatient-only (IPO) list has caused confusion among surgeons, hospitals, and patients. The purpose of this study is to determine whether similar confusion was present after CMS recently removed total hip arthroplasty (THA) from the IPO list.

Methods: We surveyed the American Association of Hip and Knee Surgeons membership via an online web-based questionnaire in February 2020.

Survey of AAHKS International Members on the Impact of COVID-19 on Hip and Knee Arthroplasty Practices.

Background: Coronavirus disease 2019 (COVID-19) pandemic poses an important risk to global health.

Methods: This study surveyed 370 international orthopedic surgeons affiliated with the American Association of Hip and Knee Surgeons to help identify the global impact of the COVID-19 pandemic on patient care.

Results: A total of 99 surgeons (27% of those surveyed) completed the questionnaire representing 32 different countries.

American Association of Hip and Knee Surgeons Advocacy Efforts in Response to the SARS-CoV-2 Pandemic.

As soon as it became clear that our economy was going to be paralyzed by the SARS-CoV-2 pandemic, the American Association of Hip and Knee Surgeons leadership acted swiftly to ensure that our members were going to be eligible for the anticipated federal economic stimulus. The cessation of elective surgery, enacted in mid-March and necessary to stop the spread of the SARS-CoV-2 virus, would surely challenge the solvency of many of our members' practices. Although our advocacy efforts discussed further have helped, clearly more relief is needed.

Surgeons' Preoperative Work Burden Has Increased Before Total Joint Arthroplasty: A Survey of AAHKS Members.

Background: Implementation of rapid recovery protocols and value-based programs in total joint arthroplasty (TJA) has required changes in preoperative management, such as optimization, education, and coordination. This study aimed to quantify the work burden associated with preoperative TJA care.

Methods: Two web-based surveys were distributed to surgeon members of the American Association of Hip and Knee Surgeons.

Quantifying Surgeon Work in Total Hip and Knee Arthroplasty: Where Do We Stand Today?

Background: Physician work is a critical component in determining reimbursement for total joint arthroplasty (TJA). The purpose of this study is to quantify the time spent during the different phases of TJA care relative to the benchmarks used by the Centers for Medicare and Medicaid Services.

Methods: We retrospectively reviewed all patients captured in our institutional joint database between January 1, 2014, and December 31, 2018.

The Unintended Impact of the Removal of Total Knee Arthroplasty From the Center for Medicare and Medicaid Services Inpatient-Only List.

Background: Total knee arthroplasty (TKA) was removed from the Centers for Medicare and Medicaid Services (CMS) Inpatient-Only (IPO) list starting January 1, 2018. Many hospitals responded by instructing surgeons to schedule all TKAs as outpatient procedures, and some local Medicare Advantage contractors began to expect outpatient status for all or most TKA cases. This activity and ensuing confusion has caused considerable unintended disruption for surgeons, hospitals, and patients.