American Association of Orthopaedic Surgeons (AAOS) President Joseph A. Bosco III, MD, FAAOS, issued the following statement in response to the newly released Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.
Among other policy changes, the Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate the Inpatient Only List beginning with nearly 300 musculoskeletal-related services, adjust the criteria for procedures covered in the ambulatory setting, and remove certain restrictions on the expansion and development of physician-owned hospitals, AAOS notes in a news release.
“The AAOS believes that the setting where patients receive their care is best decided by physicians and thus, we support policies which give orthopaedic surgeons and their patients greater choice. While we are cautiously optimistic about CMS’ attempt to offer these flexibilities by promoting site neutrality and lifting restrictions on high-value physician-owned hospitals, we are concerned about the potential for unintended consequences associated with eliminating the Inpatient Only List.
“In pushing forward such a drastic change, CMS may exacerbate many of the same unresolved issues that our surgeons continue to face as a result of hip and knee arthroplasty being recently removed from the Inpatient Only List. Payers, including Medicare Advantage and commercial carriers often misinterpret the policy change to mean that these procedures must be performed exclusively in the outpatient setting. This confusion adds even more delay and paperwork to existing prior authorization requirements and, most importantly, jeopardizes patients’ safe, timely access to care.
“The AAOS believes that determining the appropriate setting of care should be done through the lens of patient safety and peer-reviewed evidence, and that physicians are best qualified for leading this individualized decision-making process with their patients. We strongly encourage CMS to carefully reassess this aspect of the proposal in light of these concerns, and we look forward to offering our formal comments on behalf of the musculoskeletal community.”
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