AAHKS Responds to CMS Proposed Cuts to Total Joint Arthroplasty
For Immediate Release
August 6, 2020
Rosemont, Ill. — On August 4, the Centers for Medicare & Medicaid Services (CMS) released the Physician Fee Schedule proposed rule for the 2021 calendar year. The proposal significantly impacts hip and knee surgeons and their health care professional teams by devaluing the procedures they perform which help return patients suffering from joint disease to productive, pain-free lives.
AAHKS is disappointed that CMS chose to accept the recommendations of the American Medical Association’s Relative Value Scale Update Committee (RUC) to reduce the relative value units (RVU) that CMS will use to measure the value of total joint arthroplasty. The RUC recommendations reduce the RVU by a little more than one unit.
This will hit surgeons and their practices especially hard at a time when many are struggling to recover after being shut down due to the COVID-19 pandemic. CMS and the U.S. Department of Health and Human Services are stretching their legal authority to ease regulatory burdens and deliver billions of dollars in health provider relief with one hand and cutting physician payments with the other.
The RUC review was triggered by a commercial insurance company that exploited the CMS public nomination process for potentially misvalued codes, possibly to drive down reimbursement to their contracted physicians who are paid a percentage of Medicare rates. The RUC’s evaluation of these codes noted a reduction in physicians’ post-operative time due to emerging efficiencies under value-based care arrangements, but did not recognize corresponding increases in physicians’ pre-operative time which has successfully improved clinical outcomes for hip and knee replacement patients.
“If these Medicare cuts are finalized, it sends a strong signal: when providers in the vanguard of value-based care begin to achieve some efficiencies in the delivery of care, CMS will use those positive developments as a justification to cut Medicare fee-for-service reimbursement regardless of the extra work that goes into achieving these outcomes,” said C. Lowry Barnes, MD, AAHKS President.
CMS has acknowledged that the time surgeons spend before surgery with Medicare patients is not currently accounted for. “AAHKS is deeply disappointed that the AMA RUC and CMS, despite our extensive advocacy efforts over the last 21 months, chose not to give us credit for the pre-optimization work that they acknowledged is being done by our surgeons. We will continue to work with them to facilitate a mechanism by which this critically-important work can be incorporated into their methodologies,” said James I. Huddleston III, MD, AAHKS Advocacy Committee Chair.
AAHKS continues to place a high priority on its research and advocacy agenda and looks forward to working with CMS as well as our allies in Congress to correct this issue.
About the American Association of Hip and Knee Surgeons (AAHKS)
Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education, advocacy and research. AAHKS has a membership of over 4,000 surgeons and other hip and knee health care professionals.
Denise Smith Rodd