AAHKS Responds to CMS Outpatient Rule and TKA Reimbursement Change
For Immediate Release
November 10, 2017
Rosemont, IL – The Centers for Medicare & Medicaid Services (CMS) released the 2018 Medicare Hospital Outpatient Prospective Payment System (OPPS) Final Rule on November 1. CMS finalized their earlier proposal to remove total knee arthroplasty (TKA) from the inpatient only list (IPO). Medicare will now reimburse TKA procedures performed on an inpatient or outpatient basis, and CPT code 27447 will be assigned to C-APC 5115 with status indicator J1.
The American Association of Hip and Knee Surgeons (AAKHS) agrees with CMS’s statement that “the decision regarding the most appropriate care setting for a given surgical procedure is a complex medical judgment made by the physician based on the beneficiary’s individual clinical needs and preferences.” It is important to AAHKS that surgeons and patients choose the appropriate setting and time of discharge after surgery without influence by negative incentives or reimbursement consequences. This requires that CMS closely monitor emerging data as this policy is implemented to measure the impact on the BPCI and CJR models.
CMS said that in evaluating this proposal they considered stakeholder input along with recent peer-reviewed publications reporting the feasibility of outpatient TKA with positive results; that is, that TKA outpatients did not experience higher rates of complications or readmissions in comparison to TKA inpatients. CMS defers to providers to develop evidence-based patient selection criteria to identify patients who are appropriate candidates for an outpatient TKA procedure as well as exclusionary criteria that would disqualify a patient from receiving an outpatient TKA procedure. CMS further does not expect a “substantial impact on the patient-mix for the BPCI and CJR models” from this change.
We appreciate the deliberate pace CMS has adopted to date in moving toward removal of TKA from the IPO. We encourage CMS to continue such thorough evaluation of stakeholder feedback and potential unintended consequences before moving forward with removing total hip arthroplasty (THA) or any other procedures from the IPO.
About the American Association of Hip and Knee Surgeons:
Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education and advocacy. AAHKS has a membership of over 3,700 surgeons and other hip and knee health care professionals.
Denise Smith Rodd