ARTICLE SUMMARY:
As president of one of the largest independent MSK physician practices in Texas, and a member of the AAOS’ Coding, Coverage and Reimbursement Committee, Hussein Elkousy is on the front lines in responding to Medicare’s policy shifts regarding payment for some of the highest volume surgeries. While he favors the agency’s proposed policy shifts reinstating the inpatient-only rules and ASC coverage criteria, he is concerned about potential ramifications to stakeholders.
At the beginning of 2021, the Centers for Medicare and Medicaid Services implemented major changes to the Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC), eliminating the inpatient only (IPO) list and relaxing criteria for covering procedures done in the ASC setting. Even those providers already attuned to long-term reimbursement trends pushing more procedures to the outpatient setting were jolted by its scale and abruptness. Although the changes were to take place across specialties over three years, the initial hit was to musculoskeletal (MSK) care.
The implications for providers and vendors were huge, as it meant dramatic changes in the way healthcare facilities are reimbursed for surgical procedures. Pushback came immediately, and in July CMS proposed reversing these policies.
