PSH model difficult for some facilities to implement. For example,
optimizing the overall health of patients before they arrive for surgery
is challenging. However, as more complex procedures move to the
outpatient arena, the benefits of following these models are becoming
more apparent. We're entering an era of optimizing the pre-op health
of patients to prepare them for the physical stress of surgery and
recovery. It's time to get onboard with that movement.
CMS sees the light
Many surgeries — despite being appropriate for outpatient facilities —
are not yet given the outpatient designation by CMS. While ASCs are
eager to replace the joints of Medicare beneficiaries, the lack of a pay-
ment code is preventing access to this potentially profitable patient
population.
There's hope on the horizon, however. CMS removed total knee
replacement from the inpatient-only list in its 2018 Final Payment
Rule. While CMS didn't add total knees to the list of ASC-payable pro-
cedures, removing it from the inpatient-only list was an important first
step toward CMS paying for replacements performed in surgery cen-
ters. CMS didn't remove total ankle, total hip and partial hip replace-
ments from the inpatient-only list, but is listening to comments about
those procedures and will revisit the topic in the future. CMS's appar-
ent openness to reimburse for total joints in the outpatient setting
could lead to the eventual move of other inpatient-only procedures to
ASCs.
Retail medicine has the potential to pump the brakes on the outpa-
tient boom. As we saw with CVS's recent purchase of Aetna, large cor-
porations are moving into the healthcare industry. CVS already offers
"Quick Care" providers in their stores, where physicians do routine
exams and even monitor chronic conditions such as high blood pres-
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