AAOS November 14, 2017
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CMS Finalizes Outpatient and ASC Rule, Removes TKA From IPO List

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CMS Finalizes Outpatient and ASC Rule, Removes TKA From IPO List

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, which includes updates to the 2018 rates and quality provisions, and other policy changes.

Importantly, the rule finalizes changes to the Medicare inpatient-only (IPO) list for CY 2018. AAOS recognizes CMS for removing total knee arthroplasty (TKA) from the IPO list and for acknowledging this decision should be “made by the physician based on the beneficiary’s individual clinical needs and preferences.” AAOS further acknowledges CMS for noting that “the surgeons, clinical staff, and medical specialty societies who perform outpatient TKA and possess specialized clinical knowledge and experience” are most suited to create guidelines to identify appropriate candidates. AAOS is currently developing measures to assist selection of the ideal candidate for these procedures.

“AAOS supports the removal of TKA from the IPO list,” wrote AAOS President William J. Maloney, MD in the comment letter. “The determination of how to best provide adequate and timely care to a Medicare beneficiary should fall under the purview of the patient-surgeon relationship, as these are the individuals who shoulder the risk of these procedures… Further,  AAOS is currently developing outcomes measures to assist optimal selection of the ideal candidate for these procedures. The medical specialty societies engaged in such activities are best positioned to develop evidence-based patient selection and exclusionary criteria for determining the clinical acceptability of performing TKA as an outpatient procedure.”

While the AAOS suggested total ankle arthroplasty (TAA), total shoulder arthroplasty (TSA) and others should also be removed from the IPO list, CMS chose not to remove these procedures now to allow for further discussion. They acknowledged, however, that they will take these requests into consideration. 

Further, while CMS is not adding TKA to the ASC covered surgical procedures list for CY 2018, AAOS is encouraged by the progress announced in the final rule and will work closely with CMS to ensure this important next step happens as soon as possible. AAOS looks forward to continuing to work with CMS on this and other outpatient and ambulatory surgery center issues.

Finally, in a press release, CMS also emphasized drug prices and rural communities, noting that the Hospital Outpatient payment rule “will lower out-of-pocket drug costs for people with Medicare and empower patients with more choices.” According to CMS, the rule “finalized today increase access to care” and “takes steps to preserve access in rural communities.”

“As part of the President’s priority to lower the cost of prescription drugs, Medicare is taking steps to lower the costs Medicare patients pay for certain drugs in the hospital outpatient setting. Medicare beneficiaries would benefit from the discounts hospitals receive under the 340B Program by saving an estimated $320 million on copayments for these drugs in 2018 alone,” said Seema Verma, Administrator of CMS.

To read the full AAOS comments online, click here.

For a fact sheet on the OPPS final rule with comment period, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-01.html.

The OPPS final rule with comment period (CMS-1678-FC) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.