CMS wants outpatient knee replacements to be covered

The Centers for Medicare & Medicaid Services has asked for coverage of knee replacement surgeries in outpatient facilities as part of a proposal concerning hospital outpatient prospective payments.

In a separate action, the agency proposed easing how accountable care organizations deal with three-day stay waivers.

CMS patients did not experience higher complication or readmission rates than inpatients in recently analyzed outpatient procedures, according to agency researchers.

Beneficiaries would still be able to undergo the procedures in an inpatient setting if medically indicated or personally preferred, CMS officials said.

The proposed rule would appear to undermine the agency’s own bundled payment initiatives for joint replacement, according to some observers.

But officials apparently are confident enough in the potential move they are already soliciting public comment about doing the same with hip replacements.

In another proposal posted July 13, CMS recommended changes to the three-day stay waiver requirement for patients in an ACO.

An ACO would be able to apply for the SNF three-day rule waiver without the “burden” of having to submit documents describing any financial relationships between the organization, skilled nursing affiliates and acute care hospitals under the proposal.

Also, SNFs would still need to have three stars or more on the Five-Star Rating scale to receive patients as part of the waiver, but ACOs would no longer have to submit documentation showing it.

Reviews of applications to waive the rule showed that the above ACO requirements have imposed “an unnecessary burden on applicants,” CMS said.