In addition, CMS in this rule proposed removing total knee arthroplasty from the Medicare inpatient-only list, which includes procedures that are only paid for under the Hospital Inpatient Prospective Payment System. The proposed rule also seeks comment on whether partial and total hip arthroplasty should be removed from the list. AAOS supports removal of total knee arthroplasty (TKA) and total hip arthroplasty (THA) from the in-patient only list contingent on several issues, including that the surgeon be the final arbiter of the appropriate site for the surgical procedure; that there are clear criteria for surgical site and patient selection; and that payments remain site neutral.
"There has been significant movement toward performing TKA in the outpatient setting, and AAOS supports removal of TKA from the Medicare in-patient only list with several contingencies," stated AAOS President William J. Maloney, MD. "The patient’s health and well-being must always be the first priority. Therefore, the determination of how to best provide adequate and timely care to Medicare patients should fall under the purview of the patient-surgeon relationship. Additionally, there should be clear criteria for surgical site selection and it should be noted that an outpatient TKA procedure would be appropriate only for carefully selected patients. To that point, AAOS is currently developing measures to assist selection of the ideal candidate for these procedures. We look forward to continuing to work with CMS on this and other outpatient and ambulatory surgery center issues."
To read the full AAOS comments online, click here.
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