AAOS 'gravely concerned' about CMS' proposal to nix the inpatient-only list

Angie Stewart -   Print  |

The American Academy of Orthopaedic Surgeons is "gravely concerned" about CMS' proposal to eliminate Medicare's inpatient-only list, the industry group said in an Oct. 1 letter to CMS Administrator Seema Verma.

Outlined in the Hospital Outpatient Prospective Payment and ASC Payment Systems Proposed Rule, CMS' proposal to eliminate the IPO list would begin Jan. 1, 2021, with all 266 musculoskeletal procedures. AAOS takes issue with "the removal of certain procedures that do not have data to support the appropriateness" of performing them in the outpatient setting.

The organization urged CMS to slow the timeline for removing procedures from the IPO; to set general criteria for appropriate procedure selection, covering factors such as "lives alone," "pain," "prior hospitalization," "depression," "functional status," "high-risk medications," and "health literacy"; and to provide objective data on the safety of complicated procedures that are never performed in the outpatient setting before allowing them to be removed from the IPO list.

AAOS also highlighted concerns about how the proposal could affect patients' out-of-pocket costs and access to care, and asked CMS to consider waiving the two-midnight rule for procedures removed from the IPO list.

CMS' proposed elimination of the IPO list isn't the only potential change AAOS challenged. In a separate Oct. 2 letter regarding the Medicare Physician Fee Schedule Proposed Rule, AAOS addressed CMS' recommendations to significantly cut physician payment for most surgical services, decrease work relative value units for hip and knee arthroplasty, and decrease the conversion factor by 11 percent.

To address the proposed specialty payment cuts, AAOS encouraged CMS to support Congress in waiving budget-neutrality requirements that prompted the drastic measure.

"Surgeons are facing an unprecedented public health emergency coupled with economic challenges during the COVID-19 pandemic," AAOS said in its Oct. 2 letter. "Orthopedic surgeons have been lending their medical services to the response, and practices have been intermittently shuttered pursuant to CMS' recommendations to delay elective surgeries. AAOS strongly urges CMS to maintain the current funding levels. This is critical to preserving access to patient care in the wake of the COVID-19 public health emergency."

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