Becker's ASC Review

30 ORTHOPEDICS Dr. Robert Brady: How the 2020 CMS final rule will affect the spine field By Alan Condon C MS removed six spinal procedures from the inpatient-only list in the CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambula- tory Surgical Center Payment System Final Rule, issued Nov. 1. e changes took effect Jan. 1, and mean Medicare now reimburses for the procedures in both the hospital outpatient and inpatient settings. Robert Brady, MD, an orthopedic surgeon and spine specialist at Norwalk (Conn.) Hos- pital and part of Danbury-based OrthoCon- necticut, discusses how the CMS final rule will impact the field. Note: Responses are lightly edited for style and clarity. Question: How do you expect the CMS final rule to affect the spine field? Dr. Robert Brady: CMS rule changes have typically been aimed at lowering the costs of healthcare. I believe this rule change will accomplish two goals. e first is to further encourage the transition of hospital-based surgical procedures toward outpatient surgi- cal centers. It is well known that surgical centers can perform most all procedures at a lower cost and typically with greater efficiency. e second consequence is that the new rule will make it easier for payers to deny inpatient admission costs and put a greater burden on physicians and surgeons to justify and meet inpatient criteria. Q: What has been the most challeng- ing part of your practice last year? What strategies or initiatives are you planning on implementing in 2020? RB: It has always been my philosophy to practice evidence based medicine. is has been particularly relevant regarding the procedures I offer my patients. Robotic navigation for placement of pedicle screws has become a major part of my practice over the last year and a half. e robot has allowed me to become more efficient and accurate, with less intraoperative radiation, making it safer for the patient, staff and me. I am currently working on projects to expand the utility of robotic navigation to a greater portion of my procedures such as interbody insertion. Q: What is the next major regula- tory change you would like to see in healthcare? RB: I am a big proponent of empowering physicians with the ability to institute the necessary diagnostic tools and treatment protocols to provide optimal patient care. With that being said, I don't believe more regulations will achieve that goal. With the practice of evidence-based medicine, physi- cians need to be trusted with the ability to self-regulate and take the control out of the powerful insurance company lobbyist. n Judge dismisses lawsuit over Aetna's spine surgery coverage: 4 things to know By Angie Stewart A lawsuit accusing Aetna Life Insurance of wrongly denying coverage for lumbar artificial disc replacement surgery was dismissed by a federal judge, Bloomberg Law reported. Four things to know: 1. Aetna-insured patients Brian Hendricks and Andrew Sagalongos filed a class-action complaint against Aetna on Aug. 7, alleging that the insurer's practice of denying coverage for lumbar artificial disc replacement violated the Employee Retirement Income Security Act. 2. Aetna denied coverage for the spinal surgery on the grounds that this service is "experimental and investigational," the lawsuit stated. However, the plaintiffs argued that lumbar artificial disc replacement surgery has been FDA-approved for 15 years "and is a safe, effective and often recom- mended procedure that has successfully treated the symptoms of lumbar disc disease." 3. Judge Cormac J. Carney ruled that the lawsuit didn't include enough specific information. Mr. Hendricks needed to specify the health plan terms that would entitle him to benefits under ERISA, Mr. Carney said. 4. UnitedHealth and Anthem have settled similar lawsuits, according to Bloomberg Law. n Total hip replacements in ASCs vs. HOPDs: 3 key notes By Rachel Popa T otal hip replacement is safe to perform in both ASCs and hospital outpatient departments, according to research published in the Journal of Arthroplasty. Researchers collected data from 3,063 total hip replacement cases (965 were outpatient) performed by two surgeons between 2013 and 2018. Three details to know: 1. A total of 37 complications were reported within 90 days of surgery. 2. There weren't any statistical differenc- es between HOPDs and ASCs for 90- day complications, revisions, emergency department visits or readmissions. 3. Researchers concluded that total hip replacement can be performed safely in HOPD and ASC settings. n

• Cover