Surgeons push back on same-day joint replacements promoted by private health insurers

MedTech News: Twenty-four hour or “same-day” knee and hip replacements being promoted by some Australian private health insurers, such as Medibank, are not suitable for many patients, according to a recent panel discussion with leading Australian orthopaedic surgeons.

The short stay model of care aims to reduce the time spent in hospital after knee or hip replacement, allowing patients to recuperate and rehabilitate in their own home. However, according to the panellists, caution needs to be exercised to make sure that patient’s best interests come first rather than a drive to save private health funds money, similar to USA-style managed care.

“The model beginning to be adopted in Australia where private patients are having surgery in health fund-owned hospitals that make deals with doctors who work in their hospitals is clouded by vested interests” said Dr Michael Solomon, President of the Australian Arthroplasty Society.

Australian Orthopaedic Association, President, Dr Andrew Ellis stated that, “the AOA remains deeply suspicious of for-profit private health insurers who wish to enter the ownership of private surgical facilities or hospitals. They do this for business development reasons but under the guise of enhancing care in “doctor led” models. Out of pocket expenses are the smallest element in this move, as the majority of fees are paid by the commonwealth through the MBS. The real reason is to disrupt established hospital groups, and encourage alternative methods of care by offering fee incentives to surgeons to participate in managed care in health insurer owned vertical business structures.”

Medibank’s ‘No Gap Joint Replacement Program’ advises their members that they will pay no out-of-pocket for the following services as part of their hospital admission:

• Pre-admission joint school
• Hip or knee joint replacement surgery with a participating surgeon, including artificial joint
• Anaesthetist costs
• Assistant surgeon costs
• Hospital theatre/accommodation costs
• Diagnostic tests (scans and blood tests)
• And if required, rehabilitation or nursing care in the comfort of your own home delivered through ‘Medibank at Home’

The ‘No Gap Joint Replacement Program’ dictates that the surgery must be done at Medibank specified hospitals, with participating surgeons, within specified parameters, and with medical devices and technology that may not be the best option for the patient’s health needs.

Medibank’s acquisition of a 49% stake in the boutique East Sydney Private Hospital has resulted in this hospital becoming part of the ‘No Gap Joint Replacement Program’. Other participating hospital include Vermont Private Hospital (VIC), Westside Private Hospital (QLD) and Western Hospital (SA).

Panellist Professor Richard de Steiger, Deputy Director of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) said, “Over the past 12 years the length of stay for both hip and knee replacements has reduced from over 7 days to four. It is important that any further reduction in stay does not compromise the quality of joint replacement.”

Professor Christopher Vertullo, President of the Australian Knee Society commented that most cost savings can occur without rushing patients out of hospital too early. “As over 90% of patients do not require expensive inpatient rehabilitation after joint replacement, orthopaedic surgeons must ask their patients to re-think inpatient rehabilitation.”

The webinar on 29 October 2020, Short Stay Arthroplasty – the Australian experience, featured leading Australian orthopaedic surgeons discussing the benefits of short-term day surgery as an appropriate model of care for patients. While it was argued that short-term day surgery could be appropriate for up to 70% of patients, it was important for the sustainability of Australia’s health system not to push the remaining 30% of patients, who are typically older and more frail, out of hospital too early.

The panellists were unanimous in their support for shorter stay in hospitals, but highlighted it was only one factor in a whole of system approach that needed to put the patient first.

Dr David Liu, consultant orthopaedic surgeon at John Flynn Private Hospital and Honorary Adjunct Associate Professor at Bond University, said “Personalised duty of care that focuses on the patient’s individual needs and circumstances is needed. Innovation that focuses on the patient including digital technology through the use of smart apps that guides patients through pre and post rehabilitation goes a long way to providing real benefits for the patient.”

The webinar is part of a series aimed at opening transparent and robust discussion around the future of orthopaedic joint replacement, one of the costliest yet most common forms of surgery in Australia.

The next webinar Short Stay Arthroplasty – where to from now? is scheduled for 26 November 2020 and chaired by Andrew Ellis (AOA President) and Simon Coffey (Australian Society of Orthopaedic Surgeons (ASOS) President).

Panellists include:

• Michael Roff (Australian Private Hospitals Association CEO)
• Ian Burgess (Medical Technology Association of Australia CEO)
• John Horvath (Ramsay Health Care Group Chief Medical Officer)
• Jane Griffiths (Day Hospitals Australia CEO)
• Omar Khorshid (AMA Federal President)
• Stephen Graves (AOA National Joint Replacement Registry AOANJRR Director)