Published 11/3/2017

AAOS Responds to CMS Outpatient Rule, TKA Announcement

Note: AAOS is also evaluating the following final rules and will be providing further analysis on both rules shortly: (1) Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 (2) CY 2018 Updates to the Quality Payment Program. For a fact sheet on the Physician Fee Schedule final rule, please visit: For a fact sheet on the Quality Payment Program final rule with comment period, please visit:

Washington, D.C. (November 3, 2017) — On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, which includes updates to the 2018 rates and quality provisions, and other policy changes.
Importantly, the rule finalizes changes to the Medicare inpatient-only (IPO) list for CY 2018. AAOS applauds CMS for removing total knee arthroplasty (TKA) from the IPO list and for acknowledging this decision should be “made by the physician based on the beneficiary’s individual clinical needs and preferences.” AAOS further applauds CMS for noting that “the surgeons, clinical staff, and medical specialty societies who perform outpatient TKA and possess specialized clinical knowledge and experience” are most suited to create guidelines to identify appropriate candidates. AAOS is currently developing measures to assist selection of the ideal candidate for these procedures.
"AAOS supports the removal of TKA from the IPO list," wrote AAOS President William J. Maloney, MD in the comment letter. "The determination of how to best provide adequate and timely care to a Medicare beneficiary should fall under the purview of the patient-surgeon relationship, as these are the individuals who shoulder the risk of these procedures… [Further, the] AAOS is currently developing outcomes measures to assist optimal selection of the ideal candidate for these procedures. The medical specialty societies engaged in such activities are best positioned to develop evidence-based patient selection and exclusionary criteria for determining the clinical acceptability of performing TKA as an outpatient procedure."
While the AAOS suggested total ankle arthroplasty (TAA), total shoulder arthroplasty (TSA) and others should also be removed from the IPO list, CMS chose not to remove these procedures now to allow for further discussion. They acknowledged, however, that they will take these requests into consideration. 
Further, while CMS is not adding TKA to the ASC covered surgical procedures list for CY 2018, AAOS is encouraged by the progress announced in the final rule and will work closely with CMS to ensure this important next step happens as soon as possible. AAOS looks 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.
For a fact sheet on the OPPS final rule with comment period, please visit:
The OPPS final rule with comment period (CMS-1678-FC) can be downloaded from the Federal Register at:

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Kristen Coultas