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AAHKS issues guidance for members regarding CMS removal of TKA from IPO list

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For clarification purposes and to address some confusion at the provider level regarding the removal of total knee arthroplasty from the Medicare inpatient-only list, the American Association of Hip and Knee Surgeons noted in a statement from Mark I. Froimson, MD, MBA, AAHKS president, orthopedic surgeons should expect most patients to be treated as qualifying for inpatient designation.

Mark I. Froimson

This was the first of three recommendations to AAHKS members on outpatient TKA designation and, according to the statement, it coincides with the CMS statement in the 2018 Medicare o utpatient prospective payment system , which said, “the decision regarding the most appropriate care setting for a given surgical procedure is a complex medical judgement made by the physicians.”

In the second AAHKS recommendation, Froimson said, “ T herefore, all relevant parties agree that the burden of proof is on the surgeon to clearly state, not why this patient requires inpatient designation, but rather what criteria are present that suggest that inpatient resources are not expected to be utilized.”

In its third recommendation, which is focused on safe discharge and mitigating complications, AAHKS encouraged members to “only use the outpatient designation with a patient when doing so does not pose the risk of making the occurrence of, or failure to detect, such an adverse event more likely.”

AAHKS representatives met with congressional office representatives on Feb. 8-10 regarding the removal of TKA from the Medicare IPO list. The CMS’s outpatient designation for TKA does not provide evidence that this change would be safe without any adverse events, AAHKS noted in the statement.

CMS has used the “Two Midnight rule” to define outpatient status for procedures not on the IPO list, including TKA, which states, for a procedure to be considered an inpatient procedure, the hospital admission needs to be within at least two midnights. If a patient does not require at least two midnights at the hospitals, the patient may be considered an outpatient.

AAHKS is now working with the CMS to find solutions for the financial impact on patients if their payments for TKA move from Medicare Part A to Part B and for consequences AAHKS members may face if they participate in episode - based alternative payment models.

The society requested “clinical and payment consequences be thoroughly examined and that we continue to allow total knee replacement admissions to default to approved inpatient stays regardless of discharge on post-op days one or two. This will allow for time to study the outcomes of total knee arthroplasty being removed from the IPO list.”

References:

www.aahks.org/aahks-position-statement-removal-of-tka-from-inpatient-only-list/

http://www.aahks.org/wp-content/uploads/2015/02/cms-two-midnight-rule-11302017.pdf