$56 million in hip and knee reimbursement cuts avoided in final CMS ruling

Cooperative effort among physician groups helps turn aside significant cuts in CMS reimbursement for THA and TKA.

PHILADELPHIA - Physician groups working together recently helped to reverse a Medicare plan to cut some $56 million from annual reimbursements for leading orthopedic procedures, Richard F. Kyle, MD, president of the American Academy of Orthopaedic Surgeons, told the state orthopedic society here.

The recently overturned challenge came as the Centers for Medicare & Medicaid Services (CMS) considered recommendations that would have cut its reimbursements payments for total hip arthroplasty (THA) by 10% to 11%, and total knee arthroplasty (TKA) by 4% to 5%. The American Academy of Orthopaedic Surgeons (AAOS) estimated those cuts would have amounted to a $56 million loss in reimbursements for orthopedic surgeons.

The successful blocking effort helped reinforce a valuable lesson - when orthopedic specialty groups work together, they can accomplish more than with a scattergun approach, Kyle told attendees of the Pennsylvania Orthopaedic Society's Fall Scientific Meeting last week.

Orthopedics has suffered from a lack of unity as the number of specialties and specialists proliferate, Kyle noted.

“About 70% of orthopedists now identify themselves as having some kind of specialty,” he said. The AAOS has worked this year to offset this fragmentation by in part by joining forces in cases such as this CMS challenge and through other steps, such as consolidating continuing medical education, Kyle said.

“A joint effort by the AAOS, the American Association of Hip and Knee Surgeons and AMA/RUC helped convince CMS the cuts would create significant problems for access and servicing aging baby boomers,” Kyle said.

The AAOS, working with several other specialty groups, had recently established a good working relationship with CMS over the prospects for creating a joint registry, Kyle said. A registry could help CMS reach its goals of reducing health care costs by creating an evidenced-based way to weed out the least effective implants used in total joint arthroplasty, Kyle explained.

That cooperative effort gave AAOS and its coadvocates more credibility when it explained to CMS how the proposed cuts to THA and TKA reimbursements could prove counterproductive. Such cuts some of orthopedics’ highest-volume procedures could discourage future doctors from entering orthopedic training programs and reduce access to the procedures at a time when 79 million baby boomers are moving into the age group that needs them most, Kyle said.