TKR DUTCH's 2nd Knee - Onward & Upward, One Day At A Time!
- Thread starter DUTCH
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@DUTCH, I am not aware of any Medicare regulations, current or upcoming, that will force knee or hip replacements to be done on an outpatient basis. So, if you are going to make comments like this, you will need to provide a link to a source to support that statement.
There are some changes in the works in regard to Medicare reimbursement for knee and hip replacements, but they have to do with bundling services and do not dictate time frames for any procedures. All of the changes I have read about that are in conjunction with implementation of the Comprehensive Care for Joint Replacement (CCJR) model will impact how surgeons and hospitals receive payments, but should not impact the quality of care for patients.
There are some changes in the works in regard to Medicare reimbursement for knee and hip replacements, but they have to do with bundling services and do not dictate time frames for any procedures. All of the changes I have read about that are in conjunction with implementation of the Comprehensive Care for Joint Replacement (CCJR) model will impact how surgeons and hospitals receive payments, but should not impact the quality of care for patients.
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I'm glad it worked for you, Dutch. Not everyone is a suitable candidate for out-patient knee replacement, though.
skigirl
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wait---2018---we might not even be alive in 2018!! Whatever happens happens!! I would not spend any time worrying about something from the government that is supposed to happen in two or three years!!! I have lots better things to think about right now---like the frozen Greek yogurt that is in my freezer!
Agreed. But, by the same token, not everybody is NOT a suitable candidate for O-P TKR. It's up to the OS.
I was with my wife yesterday while she was seeing a knee surgeon in another well regarded (they do the Atlanta Braves, Atlanta Falcons and Atlanta Hawks) ortho group for a workmen's comp knee injury. When he saw my cane and the swollen knee, he asked; and I told him that I was one week out from O-P TKR. He then indicated that his group is successfully doing more and more TKR's as O-P, if the health of the patient is OK with it. He also said that, with the newer and continually improving techniques and ongoing Medicare funding cutbacks, the number of O-P procedures will continue to increase.
Please don't shoot the messenger. I am only sharing my experience, strength and hope with respect to what has worked and is working for me. Other people need to know that it can successfully be done - certainly not for everybody, but it can for some.
skigirl
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Dutch, I wonder why you are walking on a swollen, painful knee---especially to go to your wife's appt. At one week, I was at home in bed with my knee elevated about 80% of the time. Those soft tissues need to heal and the swelling needs to be addressed---and rest, elevation and compression are the ways to deal with swelling.
Elevating your leg to control swelling and pain
Using ice
Elevating your leg to control swelling and pain
Using ice
My revision done on Oct 19 (19 weeks ago) is still bit sore and swollen. If I'm able to be ambulatory, I will do it. Home therapist just left and concluded with a measurement of 102° and -4° at 8 days post op. She's happy and so am I. As has been repeated here many times, everyone's recovery is different.
susie09
junior member
@DUTCH - I have to tell you a story. I love my OS. He's a typical gruff, aloof surgeon but once you get to know him, he's really a pretty cool guy. I would never question anything he says medically and he's certainly not an alarmist but regarding insurance practices and policies...well, not so much. I saw him in his office about 3 months before my RTKR. In the course of our conversation he told me to stay on top of my insurance company and make sure that I had approval. He said all of the companies were getting more difficult to work with. He had just had a woman whose surgery was denied the day before her scheduled date and he didn't want that to happen to me. Well, I was so nervous those next few months. I constantly worried about being denied and having to appeal - I called several times but it was too early to have an answer. About a week before my date I called his secretary to see if she'd heard anything. I told her what he had said and her response was, "Oh my god, I hope he's not telling that to everyone!" Apparently they had had a problem with Medicare and one patient but it was resolved quickly (after her first surgery was cancelled) and she'd already had her replacement. All that worry for nothing. I know it's not the same type of situation but my point is that doctors know medicine but not necessarily insurance.
Your OS may be right but I tend to take anything regarding insurance - even if it came from someone at the insurance company - with a grain of salt. Talk to 3 different people and you'll get 4 different answers.
Your OS may be right but I tend to take anything regarding insurance - even if it came from someone at the insurance company - with a grain of salt. Talk to 3 different people and you'll get 4 different answers.
Josephine
NURSE DIRECTOR EMERITA
No bans! You're only voicing an opinion! As Celle said, just keep it polite and amiable and no problem.
However, I agree with your premise that this will become standard and speaking from a professional point of view, I actually see no arguments against it provided the surgeon and his staff take care to assess patients on an individual basis and not discharge just because it's the rules! It's actually becoming more and more used in the UK, much to the chagrin of those who disagree!
As it happens, I remember a time when patients weren't even allowed out of bed until their stitches were removed and were even kept in another week after that! So I've watched it progress and admission times reduce bit by bit over the decades. I'm actually a bit torn about the day case issue. On the one hand, I think patients really need the specialist care, specially pain management and observation for bleeding, clots, compartment syndrome and such, in the first 24hrs. On the other, they are probably safer at home than running the risk of MRSA infections. IOW, I'm kinda split!
skigirl
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Yes, sorry, that is what I thought too---I guess I am confused too !!!
Yes, it is the case. Point I was trying to make is that the 19 week old Right Revision is ALSO still a bit sore and swollen. I am walking around on both, and tickled pink to be as mobile as I am. Sorry I wasn't as clear on that as I should have been.
Once I learned that the surgical leg goes up last and down first, steps with a handrail are not that big of a deal.
My big problem was that my brain was trained for the surgical leg being the one done in October, so I did it backwards for this February leg; and almost ended up going down the stairs on my nose at one point. A little reeducation fixed that very quickly.
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Thanks! That explains things. It's pretty normal to have the older knee act up a little when you have the second one done. After all, you're asking it to assume a stronger role for a while and it's just letting you know about it. It does sound like you're doing well, though! I'm glad!
Glamg1979
graduate
Wow, an outpatient total knee. When I was an ortho nurse back in the 80's our total knees stayed 7-10 days and we didn't get them up out of bed until day 3 or 4. Lots of bedpan duty 
I could definitely have done my knee as an outpatient procedure but my OS wants me to stay 24-48 hrs. Think I stayed about 36 hrs and was ecstatic to go home.
I could definitely have done my knee as an outpatient procedure but my OS wants me to stay 24-48 hrs. Think I stayed about 36 hrs and was ecstatic to go home.
It seems to be. Thanks for checking.
