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Misvalued Codes

The Centers for Medicare & Medicaid Services (CMS) will soon decide whether or not to consider a Medicare funding recommendation for hip and knee replacement surgery beginning in 2021. While the agency actively evaluates how it regulates and reimburses procedures, now is the wrong time to reduce payment and imperil access to quality care.

Under CMS consideration is a potential $300 million reduction in spending for orthopedic surgery in Medicare fee-for-service (FFS) from 2021 through 2030. As many commercial insurers reimburse physicians based on Medicare FFS rates, it is expected that payments for orthopedic surgery for Medicare Advantage patients would be reduced comparably. The impact of these policies in addition to funding cuts would mean that surgeons must simultaneously take on more risk for less compensation.

Instead, CMS should maintain current funding levels during this transition and accept the data provided by the AAOS and the American Association of Hip and Knee Surgeons (AAHKS), which demonstrates increased surgeon time spent on evaluation activities related to value-based care.