Becker's Spine Review

18 SPINE SURGEONS CMS proposes increased ASC payment rates: 4 key notes By Rachel Popa C MS released its 2020 outpatient and ASC prospective payment system proposed rule, ushering in several changes for ASCs and hospital outpa- tient departments. Four things to know: 1. CMS proposed adding total knee arthroplasty 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 per- forming total knee arthroplasty or other proposed procedures in ASCs, as well as feedback on how the ASC covered procedures list could be redesigned to ex- pand 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 intended to promote site neutrality and encourage 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 general surgery procedures performed in ASCs. "We are grateful that this proposed rule continues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient depart- ments," said Ambulatory Surgery Center Association CEO Bill Prentice in a state- ment. "In addition, proposing 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 physicians to use well-established patient selection criteria to move appropriate patients to the lower-cost ASC setting." n CNS names winners of Neurosurgery's 2019 Top Paper By Alan Condon T he Congress of Neurological Surgeons unveiled the winners of the 3rd Annual Paper of the Year awards, for papers published in Neurosurgery, reported Newswise. Four insights: 1. Published in the February 2019 issue of Neurosurgery, the Top Paper of the Year was titled "Symptomatic Adja- cent Level Disease Requiring Surgery: Analysis of 10-Year Results from a Prospective, Randomized, Clinical Trial Com- paring Cervical Disc Arthroplasty to Anterior Cervical Fu- sion." 2. The paper found that fewer patients with Medtronic's Bryan Cervical Disc required surgery for symptomatic adja- cent level degeneration compared to patients with anterior cervical discectomy and fusion, but it did not achieve statis- tical significance. 3. Authors of the paper include George Ghobrial, MD, Wil- liam Lavell, MD, Jeffrey Florman, MD, Daniel Riew, MD, and Allan Lebi, MD, PhD. 4. Neurosurgery Publications Editor-in-Chief Nelson Oyesi- ku, MD, PhD, Neurosurgery Peripheral Nerve Section Editor Rajiv Midha, MD, and Neurosurgery Spine Section Editor John O'Toole, MD, were responsible for reviewing and choosing the Paper of the Year. "We are incredibly lucky to have the brightest minds in neu- rosurgery submit their original papers to Neurosurgery," said Dr. Oyekisu. "It was difficult to narrow the field to the awardees, however we are confident the selected papers each constitute a significant contribution to our field." n Alabama orthopedic practice pays $1.2M to settle billing, self- referral allegations: 5 details By Laura Dyrda B aldwin Bone & Joint in Daphne, Ala., settled a whis- tleblower lawsuit alleging it violated the False Claims Act and Stark Law. Five things to know: 1. The whistleblower alleged Baldwin Bone & Joint billed Medi- care and Tricare for physical therapy services performed by un- authorized athletic trainers and an exercise physiologist, who are not permitted to bill those federal programs. 2. The practice also faced Stark Law violation allegations be- cause of its direct compensation arrangements with physician owners. The lawsuit alleged the practice paid shareholder phy- sicians directly or indirectly related to the volume of referrals for ancillary services, according to the DOJ. 3. Baldwin Bone & Joint settled the False Claims Act and Stark Law allegations for $1.2 million and the lawsuit was dismissed. The whistleblower, a former employee, received $200,000. 4. The settlement resolves all claims. 5. The practice opened a new location on Aug. 15 in Foley, Ala. It was the practice's fourth location and located near South Bald- win Regional Medical Center, which includes five orthopedic specialists on staff. n

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