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CMS announces removal of THA from inpatient only list
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.
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.”
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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.
Vice chair, clinical effectiveness
Boston
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