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AAOS Comments on Proposed Medicare Payment Policy Changes for 2022

The American Association of Orthopaedic Surgeons (AAOS) issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed payment policy changes for Calendar Year (CY) 2022.

In both letters, AAOS thanked CMS for its ongoing efforts to reduce burden, ensure patient safety, and address the health equity gap during the COVID-19 public health emergency in addition to highlighting significant proposals that would impact musculoskeletal care.

Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems

The AAOS focused its comments on the key change being proposed—abruptly reversing the Inpatient Only (IPO) List elimination and pulling back the 298 procedures, including 266 musculoskeletal procedures, that were removed from the list on Jan. 1, 2021. It urged the agency not to make such wide swings in complicated policy decisions within short time periods, and to instead make them in a gradual, fully transparent fashion to enable affected stakeholders adequate time to prepare.

Further expanding on the comments within the letter, AAOS President Daniel K. Guy, MD, FAAOS, explained: “The Academy welcomes and encourages CMS to consult with stakeholders when important regulatory change is contemplated. When musculoskeletal procedures were identified as the first group to be eliminated from the IPO List, CMS would have benefited from a consultative effort with orthopaedic surgeons to determine the suitability of specific procedures, the impact on Medicare beneficiaries, and on the delivery of health care services. With further review, CMS has taken a step back as unintended consequences have become apparent. The AAOS is ready to be an important resource to assist CMS in making the best decisions for patients and their care.”

The AAOS pointed out that some musculoskeletal procedures can safely be done in the outpatient setting, then provided extensive recommendations on which ones should and should not be removed from the IPO List. It also reiterated that criteria for procedure selection should be based upon peer-reviewed evidence, patient factors including age, co-morbidities, social support, and decided by physicians through the lens of patient safety.

See initial media statement from Dr. Guy here.

Medicare Physician Fee Schedule
The AAOS’ concerns centered around ongoing cuts to reimbursement while expenses rise and surgeons continue to face an unprecedented public health emergency. CMS is proposing to reduce the conversion factor by 3.75 percent—per statutory budget neutrality requirements—and failed to incorporate the office/outpatient evaluation and management code updates into the global surgical codes.

“AAOS strongly urges CMS to maintain the current funding levels. This is critical to preserving access to patient care during the COVID-19 public health emergency,” wrote Dr. Guy. He also urged CMS to permanently maintain the flexibilities for telehealth services offered during the public health emergency, which have helped limit the unnecessary possible exposure for susceptible patients with in-person visits.

Another area where CMS is adjusting for the pandemic is by once again delaying the Appropriate Use Criteria for advanced diagnostic imaging.  Although AAOS is supportive of programs that improve quality and reduce unnecessary testing, it is concerned that the Appropriate Use Criteria program will detract from the developments of the Quality Payment Program and is therefore requesting that it be indefinitely delayed.

While CMS considers stakeholder feedback and finalizes the rules, the AAOS will continue to advocate its position and work closely with the agency on further improving the payment system and ultimately enhancing the care of musculoskeletal patients.

Read AAOS’ full comments on CY 2022 OPPS/ASC here.

Read AAOS’ comments on CY 2022 PFS here.

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