AAOS raises major concerns over BPCI Advanced model: 5 things to know

Practice Management

With the upcoming roll out of the Bundled Payments for Care Improvement Advanced model, the American Academy of Orthopaedic Surgeons has concerns.

Here are five things to know.

1. AAOS's main concern is the precedence of Comprehensive Care for Joint Replacement over BPCI Advanced for lower extremity joint replacement episodes. This will cause fewer independent physicians to participate in the BPCI Advanced model.

2. After reviewing data from physician group partners, AAOS physicians performing LEJR cases at CJR hospitals did not lower costs. In fact, the physician group partners reduced costs by $12.6 million performing the surgeries independently.

3. The second concern is the impact of the decision to take total knee arthroplasty out of the Medicare Inpatient Only list. The group notes various hospitals are sending TKA patients to outpatient as a default, a clear contradiction to CMS' stated positions.

4. AAOS worries hospitals will begin to immediately send TKA patients to outpatient centers even when they are not candidates for outpatient surgery.

An AAOS statement read, "Wrongly defaulting TKA cases to the outpatient setting is especially concerning for surgeons and patients in Medicare Advantage plans across the country. The Academy has heard from several surgeons across teaching hospitals, community hospitals, and urban and rural hospitals that Medicare Advantage plans are denying claims for TKA procedures not performed in the outpatient setting."

5. BPCI Advanced is a voluntary payment model designed to test bundled payments for 32 clinical episodes. It is expected to go into effect Oct. 1 and run through Dec. 31.

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