AAOS & AHA request delay for new joint replacement payment model — 7 takeaways

Spinal Tech

Various hospital and physician societies have requested that the Centers for Medicare and Medicaid Services postpone the implementation of a new payment model for joint replacements in Medicare patients, according to Medpage Today.

Here are seven takeaways:

 

1. Thomas Barber, MD, chair of the board of counselors for the American Academy of Orthopaedic Surgeons, stated two months is not ample time for healthcare facilities to create the necessary infrastructure for implementing the payment model, called the Comprehensive Care for Joint Replacement.

 

2. The AAOS wants more time to discuss with the CMS on how to implement a payment model that would work best for Medicare patients.

 

3. The Comprehensive Care for Joint Replacement payment model was issued in July and requires bundled payments for joint replacements to the lower extremities over a 90-day episode of care in 75 cities.

 

4. The American Hospital Association requested a six-month delay and also requested the "downside risk" be delayed until the third year of the program. The "downside risk" entails repaying Medicare when spending surpasses a target price. While the AHA supports the rule, they are concerned about the lack of fraud and abuse protections.

 

5. AAOS and various other stakeholders provided the CMS with major revisions to the proposed payment model. The AAOS stated in a formal comment letter that similar episode-of-care models such as the voluntary Bundled Payments for Care Initiative and the voluntary Acute Care Episode have not been "rigorously tested" to show the models lower costs and enhance patient outcomes.

 

6. Because of these lack of studies, the AAOS calls for a "systematic, incremental" approach that centers on voluntary engagement.

 

7.  The AHA urges that the physician self-referral law and the anti-kickback statute both be waived so hospitals can efficiently coordinate care and create financial arrangements that allow for success with the new payment model.

 

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