The American Hospital Association sent a letter to CMS Administrator Seema Verma, arguing against a CMS proposed rule that would allow Medicare beneficiaries to undergo total knee replacements and some cardiac procedures at ASCs.
What you should know:
1. The AHA wrote in the letter that it feels performing these procedures at ASCs would be less safe than performing them at a hospital. However, ASCA CEO Bill Prentice has a different stance. "Proposing to add total knee arthroplasty to our procedures list so soon after moving it from the inpatient-only list speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting," he said in a July press release after the proposed rule was made public.
2. The AHA stated in the letter that hospitals can observe patients for longer than 24 hours and have rescue protocols and alert systems in place in the case of unexpected complications. AHA also expressed concern that there would be an increase of hospital transfers from ASCs due to complications if the proposal is finalized.
3. In its argument against paying for total knee replacements in the outpatient setting, the AHA also raised the issue of physician ownership in ASCs, arguing it could influence the decision-making process.
4. The AHA was not alone with its concerns. The American College of Cardiology and American Academy of Orthopaedic Surgeons both supported the service-lines expansion, but stressed some considerations.
The American College of Cardiology stressed the importance of having emergency protocols in place, while the American Academy of Orthopaedic Surgeons noted ASCs should only perform joint replacement surgery on properly selected patients who are in good health generally.
Meanwhile, the Ambulatory Surgery Center Association (ASCA) submitted independent comments to Secretary Verma supporting the movement of total knee and total hip replacement procedures for Medicare beneficiaries into the ASC setting and citing the outstanding outcomes patients who have undergone those procedures in ASCs have experienced. ASCA’s comments also encourage CMS to do away with its ASC payable list and begin to use a single list of procedures approved to be performed as outpatient procedures for Medicare beneficiaries in either hospital outpatient departments or ASCs. Read ASCA’s letter here.
Read ACG's letter here.
Read AAOS' letter here.
Read AHA's letter here.