AAOS Comments on Proposed Medicare Payment Policy Changes for 2021

The American Academy of Orthopaedic Surgeons (AAOS) has issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed payment policy changes for Calendar Year 2021. In both letters, AAOS thanked CMS for its ongoing efforts to help physicians and patients during the COVID-19 public health emergency and highlighted proposals that would have a significant impact on musculoskeletal care.  

Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule
The AAOS focused its attention on the proposal to eliminate the Inpatient Only (IPO) List starting with all 266 musculoskeletal procedures. It urged the agency to consider the associated risks to Medicare beneficiaries before finalizing this “drastic proposal,” noting safety concerns, increased out-of-pocket costs and potential access to care issues for patients.

“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,” explained AAOS President Joseph A. Bosco III, M.D., FAAOS.

The AAOS asked that CMS set general criteria including social factors when forming guardrails around which procedures can be safely performed in the outpatient setting. It also urged CMS to waive the Two Midnight Rule, which continues to be a source of confusion for hospitals and private payers and administrative burden for physicians.

Medicare Physician Fee Schedule Proposed Rule
The AAOS’ concerns center around significant cuts to physician payment for most surgical services delivered to Medicare patients. These include CMS’ failure to incorporate adjustments for outpatient and office visit evaluation and management codes to global surgical codes, as well as its proposal to decrease the conversion factor by 11 percent.

“Now is not the time to reduce payment and imperil access to high quality musculoskeletal care,” wrote Dr. Bosco. “AAOS strongly urges CMS to maintain the current funding levels. This is critical to preserving access to patient care in the wake of the COVID-19 public health emergency.”

CMS also proposed moving forward with decreasing the work relative value units for hip and knee arthroplasty. AAOS emphasized its strong disagreement with the recommendation along with the American Association of Hip and Knee Surgeons, pointing out that the overall physician work for these procedures has not changed since they were last evaluated in 2013. If anything, orthopedic surgeons and their staff are spending more time on the preoperative work that is essential to the clinical success and cost-savings of Medicare alternative payment models. 

“If these Medicare cuts are finalized, it sends a strong signal: when providers in the vanguard of value-based care begin to achieve some efficiencies in the delivery of care, CMS will use those positive developments as a justification to cut Medicare fee-for-service reimbursement regardless of the extra work that goes into achieving these outcomes,” said C. Lowry Barnes, M.D., AAHKS president.

As CMS begins reading through stakeholder feedback and finalizing 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 2021 OPPS/ASC here.
Read AAOS’ comments on CY 2021 PFS here.