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Medicare Proposal To Cover Outpatient Knee, Hip Procedures Raises Patient Selection, Bundling Questions

 
• By Sue Darcey

Improvements in technology surrounding knee and hip replacements means a shorter recovery time for patients, but a recent US CMS proposal to take the procedures off the "inpatient procedure only" list means surgeons will have to carefully choose Medicare patients that are appropriate for the outpatient setting, and payment bundles could be affected.

X-ray of hip joint. Doctor pointed on area of hip joint, where pathology is detected

A proposal by the US Center for Medicare and Medicaid Services in its 2018 Hospital Outpatient Prospective Payment (OPPS) draft rule to take total knee replacement surgeries off its "inpatient procedures only" (IPO) list and to let the procedures be covered under Medicare on an outpatient basis could be a boon for some beneficiaries, but patient selection will have to be carefully weighed, payment experts say.

The agency also asked for comment in its 2018 year OPPS and Ambulatory Surgical Center proposal, released July 20, on...

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