Side Effects of Removing TKA from IPO List

The Centers for Medicare and Medicaid Services’ (CMS) decision to remove total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list in January has created complications not only for patients but surgeons and hospitals as well, according to a recent survey. 

Researchers sent a nine-question survey to active American Association of Hip and Knee Surgeons members, of whom 730 (26%) responded. Among the respondents, 59.5% said their hospitals have started scheduling all Medicare TKAs as outpatient procedures. More than three-quarters (76.1%) said the change has become an administrative burden. About half (49.8%) of respondents said patients who were admitted but did not stay a second midnight were treated as outpatients. For patients stay for less than two midnights, 43.4% of surgeons said that their hospitals will change their status to inpatient, and 40.5% said they have received requests to use proscribed documentation in order to make that change; 30.4% of respondents reported that their patients have had additional personal costs as a result of their TKA being considered an outpatient procedure. There were 257 open-ended responses, which overall described “confusion and disruption,” the researchers wrote. 

“The intent of the CMS was clear and readily acceptable, but the reaction of some hospitals and payers has been irrational,” according to the study authors. “It has become apparent that the true impact has not been appreciated by the CMS and requests by the American Association of Hip and Knee Surgeons (AAHKS) and American Academy of Orthopaedic Surgeons (AAOS) for clear admission documentation expectations or exemption of TKA from the 2-midnight rule have not been acted upon.” 

The researchers concluded that the American Association of Hip and Knee Surgeons is calling on CMS “to defuse this situation with education and clear reassurance that all the age-eligible Medicare TKA patients be allowed hospital admission status, regardless of the length of stay unless they actually go home the same day of surgery.” 

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Impact of treatment with liposomal bupivacaine on hospital costs, length of stay, and discharge status in patients undergoing total knee arthroplasty at high-use institutions 

Source: The Journal of Arthroplasty