CMS rules set 'dangerous precedent' for specialty reimbursement, AAOS president says


The American Association of Orthopaedic Surgeons takes issue with several changes in CMS' recently released final rules, according to a statement from AAOS President Kristy L. Weber, MD.

Dr. Weber criticized CMS' decision to remove hip replacements from the inpatient-only list in 2020, as well as its "failure" to apply updated evaluation and management values to global codes for 2021.

The policies under scrutiny are outlined in CMS' 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule, as well as its Medicare Physician Fee Schedule Final Rule. Both were published Nov. 1.

Dr. Weber said the removal of hip replacements from the inpatient-only list is concerning given the "unintended consequences" of its decision to remove knee replacements from the inpatient-only list in 2018.

By not applying updated E/M values to global codes — despite recommendations from the medical community — "CMS is setting a dangerous precedent," Dr. Weber said. "For orthopedics, this will mean an unfair differential in future reimbursements for specialty care."

In preparing for these new policies, AAOS urged CMS to trust and empower physicians to determine the best practice setting for their patients. The organization also asked CMS to uphold the statutory requirements of MACRA section 523(a).

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Drs. Nic Gay, Kerisimasi Reynolds team to form Silicon Valley Orthopaedics 

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