and Bundled Payment for Care Improvement (BPCI) programs.
Inpatient-only considerations
CMS first proposed removing TKA from the IPO list in 2013, but
declined to finalize that proposal after industry stakeholders opposed
the policy change on the grounds that it would be unsafe for Medicare
beneficiaries. As it does with all procedures being considered for
removal from the IPO list, CMS considered the following criteria as
applied to TKA:
• whether most outpatient departments are equipped to provide the
service to the Medicare population;
• whether the simplest procedure described by the applicable CPT
code may be performed in most outpatient departments;
• whether the procedure is related to codes already removed from
the IPO list;
• whether the procedure is being performed in numerous hospitals
on an outpatient basis; and
• whether the procedure can be appropriately and safely performed
in an ASC, and is on the list of approved ASC procedures or has been
proposed for addition to the ASC list.
CMS emphasized that it does not require a procedure to meet all 5
criteria in order to be removed from the IPO List. In support of its
decision to remove TKA from the IPO list, CMS found that TKA proce-
dures met criteria 1, 2 and 4. Importantly, CMS also declined to
include TKA on the ASC Covered Procedures List.
Impact of CMS decision
Here's a look at the far-reaching implications of CMS's decision to
remove TKA from the IPO list but to exclude it from the ASC list.
• Clinical appropriateness. Many commenters had opposed remov-
Legal Update
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