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Recent news out of Washington, D.C. may mean new opportunities for orthopedic practices. This year, CMS removed nearly 300 services from the inpatient-only list—most of them related to musculoskeletal care—a first step in eliminating this list altogether. The agency also made 11 additions to the list of procedures covered in ambulatory  surgery centers (ASCs), including total hip arthroplasty. These changes won’t only affect the orthopedic market, but will have an impact on the hospitals, health systems and more broadly the Medicare program. Commercial payers may follow suit as well—only time will tell. 

“It allows doctors and patients to make decisions about the most appropriate site of care, based on what makes the most sense for the course of treatment and the patient without micromanagement from Washington.” – (former) CMS Administrator, Seema Verma 

The intention of this rule offers more choices around surgery, putting the decision of where a patient wants to undergo surgery in the hands of physicians, surgeons, and patients. The two major changes included in this rule both fall under the banner of increasing choice and encouraging location neutrality. 

The first is eliminating the inpatient-only list over the course of the next three years, with the elimination of certain procedures from the list this year and extending over the next two years. The elimination list was started in 200  and currently has over 1700 services that can only be performed in the inpatient only setting. Starting in 2021, 298 of the 1740 services will be eliminated from the inpatient list. A majority of these changes affect the musculoskeletal market, as it makes these procedures eligible to be paid by Medicare. 

The second major change adds 11 procedures to the covered procedures list, allowing them to be performed in an Ambulatory Service Center. This allows hospitals and ASCs to operate with increased flexibility and patients to take more of an active role in where they want their care to be performed. 

To dive into this topic more deeply, listen to a recent webinar  where me and Chris Emper, government affairs advisor, provided guidance on what these new regulations mean for your practice:
Basics of the Outpatient Prospective Payment System and ASC Payment System, as well as an explanation of recent changes
What are the financial impacts of these changes on providers, patients, and third-party payers?
How are orthopedic practices and ASCs responding to new regulations?
What to look for going forward

Listen to the full webinar.

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