How CMS' 2021 payment rule will affect spine surgery at ASCs

Alan Condon -   Print  |

CMS' inpatient-only list, which has been around since 2000, will be phased out by 2024, beginning with the 266 orthopedic procedures that were removed from the list in 2021.

Sixty-seven of those 266 procedures were related to spine surgery, compared to six spine procedures removed from the IPO list in 2020.

Additionally, under CMS' revised criteria, 267 surgical procedures were added to the ASC-payable list in 2021, including total hip replacement.

This is a promising trend for ASCs, Bill Prentice, CEO of the Ambulatory Surgery Center Association, told Becker's. "It's showing the medical directors at CMS see the value and quality of care that's being provided in the ASC space and are trusting the clinical judgment of clinicians in making the right decisions about which patients can be safely seen in the ASC versus the hospital."

For spine surgeons, the changes mean that more spine procedures will be able to be performed at surgery centers as cases continue to migrate from the higher-cost inpatient setting.

More spinal fusions will be reimbursed at ASCs, which will essentially function as mini hospitals, applying for extended stay status and seeking to keep patients for up to 48 hours, said Brian Gantwerker, MD, founder of the Craniospinal Center of Los Angeles.

The downside will be some surgeons will be tempted to "bring higher acuity and higher risk patients, perhaps inappropriately, to the ASC," Dr. Gantwerker said. "Patient complication rates may go up and not improve quality of care. This may offset any savings by moving the inpatient codes to outpatient only."

Further CMS changes affecting spine surgery this year include increased prior authorization requirements. Beginning July 1, 2021, CMS will require prior authorization for cervical fusion with disc removal as well as implanted spinal neurostimulators.

The agency said it plans to use the prior authorization to ensure Medicare patients receive necessary care and reduce "unnecessary increases in the volume" of covered outpatient spine services.

Ultimately, patient demand, rising adoption of minimally invasive techniques and payers pushing more procedures to be done in the outpatient setting will accelerate migration of spine surgery to the outpatient setting.

As ASC owners stand to see a financial gain due to the changes, stakeholders such as hospitals and venture capital firms will likely become more invested in ASCs.

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