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Inpatient VS. Outpatient

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Comparing quality and cost
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5 MIN. READ
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As orthopedic procedures rise, becoming more informed about potential options for planned knee and hip replacement surgeries could help control cost. In some cases, choosing an outpatient setting could result in big savings.

As orthopedic procedures rise, becoming more informed about potential options for planned knee and hip replacement surgeries could help control cost. Powered by our Blue Cross Blue Shield The Health of America report series, we created this infographic to share key insights that can empower your employees to make the best choices for their care with their doctor. In some cases, choosing an outpatient setting could result in big savings.

Data is from examining the medical claims of 49 million adult BCBS commercially insured members for cost and quality of care for planned knee and hip replacement procedures.

242,000 adult BCBS members under the age of 65 underwent a planned knee or hip replacement. Planned knee and hip outpatient procedures are 30 to 40 percent less expensive on average than inpatient procedures.

Despite potential savings, only a small percentage of these procedures were performed on an outpatient basis. 11 percent of knee surgeries were outpatient. Inpatient knee surgeries cost $30,249 while outpatient cost $19,002. 8 percent of hip surgeries were outpatient. Inpatient hip surgeries cost $30,685 while outpatient cost $22,078.

There have been improvements in quality outcomes for both inpatient and outpatient settings over the past eight years. In fact, in 2017, complication rates for knee and hip procedures in an outpatient setting were lower than those in an inpatient setting.

The percentage of inpatient knee surgeries with any complication fell from 29.7 in 2010 to 21.1 in 2017. The percentage of inpatient hip surgeries with any complication fell from 28.3 in 2010 to 19.3 in 2017. The percentage of outpatient knee surgeries with any complication fell from 31.2 in 2010 to 16.6 in 2017. The percentage of outpatient hip surgeries with any complication fell from 21.7 in 2013 to 14.0 in 2017.

Key considerations: On a general basis, do you know where your employees' knee or hip procedures are being performed? Do you know the quality of care and outcomes for the providers facilitating these procedures? What impact could a shift to more cost-effective locations make to your medical cost? Do you have education in place to help employees understand the quality and cost benefits of having these procedures in an outpatient setting so they can have an informed conversation with their doctor?

We're here to help answer all your questions regarding cost control and orthopedic care. Visit smarterbetterhealthcare.com to contact your local BCBS company and to read the full ebook, "Controlling Cost as Orthopedic Procedures Rise."

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