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Panel Endorses Removing Total Knees from Inpatient-Only List

The Advisory Panel recently recommended that CMS remove total knee arthroplasty (TKA) from its inpatient-only list. Following a presentation by Sohrab Gollogly, MD, an orthopedic surgeon affiliated with the Monterey Peninsula Surgery Center in California, on August 22nd, the Advisory Panel on Hospital Outpatient Payment (HOP) made the unanimous recommendation to CMS.

The purpose of the HOP is to advise the Secretary of the US Department of Health and Human Services (HHS) and the Administrator of CMS on optimal strategies related to the clinical integrity of procedures within the hospital outpatient prospective payment system (OPPS), including “removing procedures from the inpatient list for payment under the OPPS payment system.”

Although the HOP’s recommendations are not binding on CMS, ASCA says it is “pleased to see this body support the movement of this code to the outpatient setting.”

“ASCA appreciates this panel’s recognition that total knee replacements can be performed safely and effectively as outpatient procedures for many patients within the Medicare population, and we hope CMS will heed this recommendation,” said William Prentice, ASCA chief executive officer. “ASCs have been performing these procedures safely on non-Medicare patients for years and are well-versed in the importance of patient selection based on a patient’s entire health profile. Age alone should not be an exclusionary factor.”

Source: Government Affairs Update, “HHS Advisory Panel Recommends Total Knees Be Removed from Inpatient-Only List,” ASCA News Digest Vol. VI, Issue 32, August 25, 2016