November 11, 2019
2 min read
Save
Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when new articles are posted on .
Added to email alerts
You've successfully added to your alerts. You will receive an email when new content is published.
Click Here to Manage Email Alerts
You've successfully added to your alerts. You will receive an email when new content is published.
Click Here to Manage Email Alerts
We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.
In its Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule, CMS announced total hip arthroplasty, six spinal surgical procedures and certain anesthesia services will be removed from its inpatient only list.
Perspective from Richard Iorio, MD
According to the release, CMS noted removal of these procedures from the inpatient only list makes the surgeries eligible to be paid by Medicare in the hospital outpatient setting in addition to the hospital inpatient setting. CMS also noted there will be a 2-year exemption from certain medical review activities relating to patient status for procedures removed from the inpatient only list beginning in calendar year 2020 and subsequent years. This differs from the original proposal of a 1-year exemption, which was changed in response to public comments, according to CMS.
“This 2-year exemption period will allow providers time to update their billing systems and gain experience with respect to newly removed procedures eligible to be paid under either the Inpatient Prospective Payment System (IPPS) or [Outpatient Prospective Payment System] OPPS, while avoiding potential adverse site of service determinations,” according to the press release.
In response to this announcement, Kristy L. Weber, MD, FAAOS, president of the American Association of Orthopaedic Surgeons, released a statement expressing the disappointment of the AAOS with the decision to remove hip replacements from the inpatient only list beginning in 2020.
“It is both troublesome and disheartening to know that the repeated concerns of the surgical community were not heeded in making this critical change to the delivery of care,” Weber said in the statement.
She noted the AAOS now asks CMS to “adequately prepare for the effect of the concerning changes” in the final rule by trusting and empowering surgeons to designate the best practice setting for their patients without being crippled by the burden of proof.
“Additionally, the statutory requirements of [Medicare Access and CHIP Reauthorization Act] MACRA section 523(a) must be upheld to ensure integrity of the relative value scale and appropriate access to surgical care,” Weber said. “We hope that the agency recognizes these impending challenges and is thoughtful about the enforcement of these new policies.”
References:
Perspective
Back to Top 
Richard Iorio, MD
I think CMS has been well reasoned in what they have done, and the reaction of the hospitals has been poorly executed. I think we’ve expected total hip to come off the inpatient only list and if they do it in a well-reasoned way and then look at the data and see if it’s safe and allow the hospitals and the surgeons to judge what the best location for care of the patient is given their comorbid status, I think we’ll be OK. This is a trial period. We’ll see how it goes.
I think CMS needs to give some guidance as to which patients are appropriate for which settings, either hospital inpatient, hospital outpatient or ASCs and the American Association of Hip and Knee Surgeons is willing to work with CMS to develop those criteria. So far, CMS has been very responsive to our suggestions and I hope they continue to be.
Richard Iorio, MD
Chief, adult reconstruction and total joint arthroplasty service
Vice chair, clinical effectiveness
Brigham and Women’s Hospital
Boston
Disclosures: Iorio reports he is a board or committee member for the American Association of Hip and Knee Surgeons; receives stock or stock options from Covina, Force Therapeutics, MedTel, Muve, URX Mobile and Wellbe; and is a paid consultant for Johnson & Johnson, MedTel, Medtronic, Muve Health, Pacira, Recro Pharma and Zimmer Biomet.
Read more about
relative value scales
medicare
orthopedic surgeon
total hip arthroplasty
inpatient
Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when new articles are posted on .
Added to email alerts
You've successfully added to your alerts. You will receive an email when new content is published.
Click Here to Manage Email Alerts
You've successfully added to your alerts. You will receive an email when new content is published.
Click Here to Manage Email Alerts
We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.
- Comment
