Becker's Spine Review

46 OUTPATIENT SURGERY CMS may add total knee replacements to ASC covered procedures list for 2020, up payment rates By Rachel Popa C MS released its 2020 outpatient and ASC prospective payment system pro- posed rule, ushering in several changes for ASCs and hospital outpatient departments. Four things to know: 1. CMS proposed adding total knee arthro- plasty to the ASC covered procedures list, along with knee mosaicplasty and three coronary intervention procedures. CMS is seeking comment on potential limitations that should be set on performing total knee arthroplasty or other proposed procedures in ASCs, as well as feedback on how the ASC covered procedures list could be redesigned to expand physicians' ability to choose the appropriate setting of care for their patients. Comments are due to CMS Sept. 27. 2. CMS also proposed removing total hip arthroplasty from the inpatient only list, making the procedure eligible for Medicare reimbursement in the hospital outpatient and inpatient setting. 3. CMS finalized its proposal to apply the hospital market basket update to the ASC payment system for five years and proposed to update ASC payment rates for 2020 by 2.7 percent for ASCs that meet quality reporting requirements. CMS said the change is intend- ed to promote site neutrality and encour- age the shi of outpatient procedures from HOPDs to ASCs. 4. CMS didn't remove any measures from the ASC quality reporting program for 2020 but did propose adopting a claims-based measure in 2024 for seven-day hospital visits aer gen- eral surgery procedures performed in ASCs. "We are grateful that this proposed rule con- tinues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient departments," said Am- bulatory Surgery Center Association CEO Bill Prentice in a statement. "In addition, pro- posing to add total knee arthroplasty to our procedures list so soon aer moving it from the inpatient-only list speaks well to the con- fidence that CMS has in the ability of physi- cians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting." n CVS to launch pilot program for Aetna beneficiaries undergoing total knee replacement surgery By Rachel Popa C VS plans to launch a pilot program this summer to help Aetna knee replacement surgery patients with care be- fore and after their procedures, an Aetna spokesperson confirmed to Becker's Spine Review. The program aims to cut costs by decreasing hospital readmission, the spokesperson said. The program was announced by CVS CEO Larry Merlo at the Medicare Advantage conference in Washington, D.C. July 23, according to a report from Healthcare Dive. The coordinated care pilot will manage pre- and postoperative care for patients through CVS pharmacy locations, an at-home clinical team and telehealth. According to Healthcare Dive, a video shown at the conference depicted an Aetna beneficiary consulting a CVS case manager to check whether her knee replacement surgeon was in network and to schedule a postoperative assessment. The patient in the video was also shown using the CVS pharmacy to manage her prescriptions and buy a cane to use after her operation. CVS declined to disclose where the pilot would run. n Physician-owned micro- hospital opens in Oklahoma — 3 details By Angie Stewart T ulsa (Okla.) ER and Hospital, a physi- cian-owned micro-hospital, opened its doors to patients July 29, according to local news station ABC 8 Tulsa. Three details to know: 1. Tulsa ER and Hospital is a privately owned hospital and does not accept Medicare or Medicaid. It has ap- plied to be in-network with major insurance compa- nies. At this time, the hospital does not have any in-net- work contracts but Medical Director Mark Blubaugh, DO, told ABC 8 that the hospital plans to charge in-net- work rates for patients with private insurance. 2. Tulsa ER and Hospital is half the size of a tradi- tional hospital, but still offers patients the same treat- ment and equipment. 3. The hospital plans to post prices for procedures online and will set a flat fee for services such as X-rays, ultrasounds and CT scans. n

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