Kaitlyn D’Onofrio

DocwireNews

The Centers for Medicare and Medicaid Services&rsquo; (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.&nbsp;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.&nbsp;More than three-quarters (76.1%) said the change has become an administrative burden.&nbsp;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,&nbsp;43.4%&nbsp;of surgeons&nbsp;said that&nbsp;their&nbsp;hospitals will change their status&nbsp;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 &ldquo;confusion and disruption,&rdquo; the researchers wrote.&nbsp;&ldquo;The intent of the CMS was clear and readily acceptable, but the reaction of some hospitals and payers has been irrational,&rdquo; according to the study authors.&nbsp;&ldquo;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&nbsp;Orthopaedic&nbsp;Surgeons (AAOS) for clear admission documentation expectations or exemption of TKA from the 2-midnight rule have not been acted upon.&rdquo;&nbsp;The researchers concluded that the&nbsp;American Association of Hip and Knee Surgeons&nbsp;is calling on CMS &ldquo;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.&rdquo;&nbsp;<a href="https://proddocwire.wpengine.com/docwire-pick/decreased-risk-total-knee-arthroplasty/">Take Five: Just A Few Minutes of Brisk Walking Associated with Decreased Risk of TKA</a>&nbsp;<a href="https://proddocwire.wpengine.com/future-of-medicine/improving-total-knee-replacements-with-robotic-arm-assisted-surgery/">Using Robots in Total Knee Replacements</a>&nbsp;<a href="https://proddocwire.wpengine.com/abstracts/aspirin-venous-thromboembolism-patients/">Association of Aspirin&nbsp;With&nbsp;Prevention of Venous Thromboembolism in Patients After Total Knee Arthroplasty Compared With Other Anticoagulants: A Noninferiority Analysis</a>&nbsp;<a href="https://proddocwire.wpengine.com/abstracts/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/">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</a>&nbsp;Source:&nbsp;<a href="https://www.arthroplastyjournal.org/article/S0883-5403(18)30824-6/fulltext">The Journal of Arthroplasty&nbsp;</a>

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Side Effects of Removing TKA from IPO List

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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 ...

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