Beginning Jan. 1, 2018, CMS removed total knee replacements from Medicare inpatient-only list.
The 2018 Outpatient Prospective Payment Systems Final Rule did not add total knee replacements to the list of procedures covered in ASCs. Medline's Outpatient Outcomes magazine highlighted how ASCs reacted to the ruling.
Here are the key details to know:
1. ASC administrators expressed hope that total knee replacement surgeries to the ASC Covered Procedures List in the future. However, the proposed 2019 payment update does not include adding total joints to the ASC payable list next year.
2. Moving forward into 2019, ASCs will continue collecting data on procedures outcomes for private payer patients who undergo total joint procedures in the ASC.
3. ASCs where surgeons aren't currently performing total joint replacements may decide to add the procedure in the future. Total joint replacements are more complex than the traditional, low acuity cases in the ASC, and the implants add to the cost per case. However, depending on the reimbursement rate, ASCs could see improved profitability due to these procedures.
4. Total joint replacements in the ASC typically cost less than in the hospital. “The cost savings associated with ASCs should be a major consideration for Medicare and all other payers,” Sandra Barreth, administrator of the Sansum Clinic Foothills Surgical Center told Medline.