Published 11/30/2019
Alix Braun, MPH; Kristen Coultas

AAOS Responds to Concerning Changes in CMS 2020 Final Payment Rules

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) issued two final rules that will have significant impact on physician reimbursement, patient safety, and access to care: the 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center (OPPS/ASC) Payment System Final Rule and the Medicare Physician Fee Schedule (MPFS) Final Rule.


AAOS was glad to see that CMS finalized several proposals the Academy supported in OPPS/ASC, including the addition of total knee arthroplasty to the ASC-covered procedures list, the removal of six surgical spine codes from the inpatient-only (IPO) list, and a two-year exemption from certain medical review activities relating to patient status for procedures removed from the IPO beginning in January 2020. However, despite strong rebuke from AAOS and others, CMS finalized the removal of total hip arthroplasty from the IPO.

AAOS President Kristy L. Weber, MD, FAAOS, issued the following statement in response to the concerning change: “AAOS is extremely disappointed with CMS’ decision to remove hip replacements from the IPO list beginning [in] 2020, especially as the removal of knee replacements in 2018 and the unintended consequences of that policy change continue to plague Medicare providers and threaten patient safety. It is both troublesome and disheartening to know that the repeated concerns of the surgical community were not heeded in making this critical change to the delivery of care.”


In the MPFS, AAOS appreciated that CMS refrained from requiring Qualified Clinical Data Registries to provide educational services in quality improvement. The Academy also values the clarification that measures only need to link to a cost measure, improvement activity, or a Merit-based Incentive Payment System Value Pathway. AAOS’ concern lies in the agency’s decision to only apply updated evaluation and management (E/M) code values to office/outpatient visits, despite strong warnings from surgical specialty societies, including AAOS, as well as Congress.

Dr. Weber responded to this change by saying, “Furthermore, CMS is setting a dangerous precedent for the future of musculoskeletal procedures and their perceived value—despite our aging population. In failing to apply updated E/M values to global codes for 2021, the agency has chosen to blatantly disregard recommendations from the medical community and disrupt the relativity mandated by Congress for the Medicare fee schedule. For orthopaedics, this will mean an unfair differential in future reimbursements for specialty care.”


In the coming weeks, AAOS will provide members with additional information on the changes that were finalized and the impact they will have on musculoskeletal care. For now, AAOS asks that CMS adequately prepare for the effects of these concerning changes. “Physicians must be trusted and empowered to designate the best practice setting for their patients and not be crippled by the burden of proof,” said Dr. Weber. “Additionally, the statutory requirements of Medicare Access and CHIP Reauthorization Act section 523(a) must be upheld to ensure integrity of the relative value scale and appropriate access to surgical care. We hope that the agency recognizes these impending challenges and is thoughtful about the enforcement of these new policies.”

Visit https://go.cms.gov/2OiGnCG to learn more about OPPS/ASC. Visit https://go.cms.gov/2CGYgFx to learn more about MPFS.

Alix Braun, MPH, is a regulatory advocacy specialist in the AAOS Office of Government Relations (OGR).

Kristen Coultas is the communications manager in the AAOS OGR.