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CMS's push to move revision total knee arthroplasty (TKA) off the inpatient-only list is raising alarms. A new study finds hospitals are losing significant money on these complex procedures, and lower reimbursements could drive surgeons and facilities away from treating high-risk patients. Experts are now calling for fair pay and the creation of dedicated revision centers of excellence.
A new study presented at the American Association of Hip and Knee Surgeons Annual Meeting is sounding the alarm on CMS's proposal to remove revision total knee arthroplasty (TKA) from the inpatient-only list. Researchers found that shifting these complex procedures to an outpatient designation could create negative financial margins for hospitals and ultimately reduce access to care for the sickest patients who need it most.
The study, which reviewed 2,265 revision TKA cases from 2017 to 2025, revealed a stark gap between what these procedures cost and what insurers reimburse. Specialty hospitals managed to keep costs lower, but only by handling simpler cases with healthier patients — leaving community and tertiary hospitals to absorb the financial burden of the most complex revisions.
By the Numbers:
Why it matters: As reimbursement rates fall, fewer surgeons and facilities may be willing — or financially able — to take on high-risk revision cases. Advocates are pushing for fair reimbursement models and dedicated revision centers of excellence to ensure complex patients don't get left behind.
