The American Academy of Orthopaedic Surgeons, along with several orthopedic specialty and state societies, sent CMS administrator Seema Verma a letter commenting on CMS’ decision to take total knee arthroplasty out of the Medicare Inpatient Only list.
Here are five things to know.
1. The letter claims that there has been confusion regarding how to implement this new rule. CMS designates the Medicare beneficiary’s physician as the medical professional responsible for determining the care setting in this rule, but AAOS is concerned that unqualified decision making on the site of service will harm beneficiaries, especially those who have multiple risks such as comorbidities and advanced age that are not conducive to an outpatient procedure.
2. AAOS asks for clarification on whether surgeons’ reimbursements will be affected by this policy change.
3. In addition to deciding to remove TKA off the IPO list, CMS made TKA procedures subject to the “Two-Midnight Rule,” in which a hospital admission should span at least two midnights in order to be covered as an inpatient procedure. The letter requests CMS issue an exception to the “Two-Midnight Rule” for TKA procedures.
4. The letter requests the CMS Center for Clinical Standards and Quality to direct quality improvement organizations to get involved and take up any compliance questions and issues related to potential audits.
5. The letter identifies the issue of wrongly defaulting TKA cases to the outpatient setting as especially concerning for surgeons and patients in Medicare Advantage plans. The letter asks CMS to use its MA plan oversight authority to intervene to ensure that MA plan beneficiaries are not unfairly disadvantaged over their fee-for-service counterparts.
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