8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 7
Last month, CMS released its 2018 proposed payment rule
for ASCs and HOPDs. CMS currently doesn't reimburse for
total joint replacement in ASCs, but is proposing to
remove total knee arthroplasty from the inpatient-only
(IPO) list and include it on the ASC-payable list. CMS is
also requesting comments on whether partial and total hip
arthroplasties should also be removed from the IPO list. Is
2018 the year you'll be able to perform total joint proce-
dures on Medicare patients in the ASC setting?
David Uba, MBA, the CEO of Excelsior Orthopaedics in Amherst, N.Y., believes it
will happen. "I'm hopeful that public comments will demonstrate to CMS that outpa-
tient total joints can be done in the Medicare patient population safely and effective-
ly, just as surgeons have done in the commercial patient population for years," he
says.
Mr. Uba thinks adding total joints to CMS's ASC payment list would increase
demand for outpatient joint replacement and provide additional revenue for his
practice and its ASC. "We turn Medicare patients away almost every day," he adds.
"Many of these patients would otherwise meet our patient selection criteria."
Commercial payers have previously been reluctant to allow for outpatient joint
replacement, because they've followed CMS guidelines, according to Mr. Uba. He
believes that once CMS gives outpatient total joints the green light, other insurers
and payers will happily add Medicare Advantage product lines to existing bundled
payment arrangements.
Says Mr. Uba, "If you haven't done so already, now's the time to get your outpa-
tient total joint program off the ground."
— Daniel Cook
REIMBURSEMENT UPDATE
Will CMS Pay for
Same-Day Joints in 2018?
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