Practical takeaways
Surgeons should begin evaluating patients on a case-by-case basis to
determine whether an inpatient admission would be medically neces-
sary and appropriate under the two-midnight rule criteria. Similarly,
hospitals should begin working with orthopedists and others to devel-
op patient selection protocols to determine if individual TKAs should
be performed in the inpatient or outpatient setting.
Finally, BPCI and CJR hospitals (especially those hospitals that have
the option to discontinue participation in the CJR program) should
evaluate the likelihood that migration of healthier TKA patients to the
outpatient setting will adversely affect financial performance under
the BPCI and CJR programs. Those hospitals that continue to partici-
pate in the BPCI and CJR models should also be prepared to provide
CMS with data on migration of TKAs to the outpatient setting over the
remaining payment model performance years.
OSM
Ms. Skeels (jskeels@hallrender.com) is a healthcare attorney in Hall Render's
Indiana, Ind., office. Ms. Lucido (llucido@hallrender.com) is a healthcare
attorney in Hall Render's Troy, Mich., office.
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