October 25, 2023

Orthopedic surgeons’ association flags vital pros and cons.

COLD SHOULDER Despite increasing calls by orthopedic surgeons to perform same-day shoulder replacements at ASCs, the procedures remain on CMS’ inpatient-only list in its 2024 proposal.

As orthopedic ASCs continue to be built and developed due to overwhelming demand for their services and the value and convenience they provide, the Medicare reimbursement picture for these facilities remains murkier than most would prefer. The latest example of this are the proposed changes for 2024 from the Centers for Medicare & Medicaid Services (CMS), which include a 3.2% cut in the conversion factor used to determine physicians’ reimbursements.

The American Association of Orthopaedic Surgeons (AAOS), submitting its formal comments on CMS’ proposed changes, says a statutory fix is needed to provide an annual inflationary pay update for physicians’ Medicare cases rather than the current annual calculation method, which AAOS President Kevin J. Bozic, MD, MBA, FAOS, says has resulted in orthopedic and other surgeons falling behind.

“By some estimates, the Medicare Physician Fee Schedule (PFS) conversion factor would have been double the amount being currently proposed, had it kept up with inflation,” he says. AAOS says the current reimbursement system makes it more difficult for its members to ensure high-quality specialty care and makes equitable access to that care more difficult for Medicare beneficiaries.

AAOS additionally opposed the use of Healthcare Common Procedure Coding System code G2211 for existing evaluation and management (E/M) visits, which would provide an add-on payment for complex cases that Dr. Bozic says will negatively impact surgeons and their patients. “This code is unnecessary due to the new office or outpatient E/M coding structure,” explains Dr. Bozic. “Existing codes are available for reporting the work and time across various complexity levels which make code G2211 duplicative of work that is already represented in the CPT code set.”

Also opposed by AAOS was CMS’ proposal to reimburse sacroiliac joint arthrodesis (CPT codes 27279 and 2X000) when performed in office settings.

AAOS liked some other aspects of CMS’ 2024 PFS plan. It supports CMS’ proposals to expand telehealth services, continue the implementation delay of the 2017-based Medicare Economic Index and indefinitely pause implementation of the Appropriate Use Criteria program for advanced diagnostic imaging services.

AAOS also commented on CMS’ 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS/ASC) proposal, which despite strong requests from those in the specialty does not remove any additional orthopedic procedures from the inpatient-only (IPO) list. That includes total shoulder replacements, which many surgeons believe are safe to perform in outpatient settings and they are keen to do so. AAOS urged CMS to include experts’ knowledge and peer-reviewed evidence when making these decisions in the future.

Dr. Bozic says surgeons and their patients should decide on the appropriate setting for surgery and that no mandates or pre-authorization requirements should be necessary to determine whether a procedure should be inpatient or outpatient, even if a procedure moves out of the IPO list.

AAOS supported the decision to extend the hospital market basket-based updates for ASCs, requesting that CMS permanently update ASC payments based on this methodology.

AAOS also commented on CMS’ proposal to adopt the Risk-Standardized Patient-Reported Outcome-Based Performance Measure (PRO-PM) for elective total hip and knee arthroplasties in HOPD settings. “AAOS is encouraged by the move towards focusing on outcomes that matter to patients, and given our vast experience with PRO measurement, AAOS provided several recommendations for successful implementation, including allowing a slower ramp to mandatory reporting, clarifying the purpose of patient reported outcomes reporting and creating a reimbursement pathway for wider and easier adoption of outcomes measurement in the Medicare program,” wrote AAOS.

Click the links to download AAOS’ full letters to CMS regarding its PFS and OPPS/ASC proposals.

Eugene Jewett, MD Surgery Center’s inaugural total hip replacement kicks off the 375,000-square-foot facility’s quest to dominate Florida ortho care.

Orlando Health
ALL IN ONE PLACE The goal of the massive Orlando Health Jewett Orthopedic Institute is to provide everything an orthopedics patient needs at a single location.

When orthopedic surgeon George Haidukewych, MD, performed a direct anterior outpatient total hip replacement at the Eugene Jewett, MD Surgery Center in Orlando, Fla., it was a momentous occasion for all involved.

The inaugural total joints case was performed at a newly constructed surgery center that features 12 ORs, a nano-suite for minimally invasive sports medicine technology and patient access to imaging, pharmacy services and physical therapy — all within the same outpatient facility. Every patient at the center receives a visit from a member of the rehabilitation team to begin physical or occupational therapy right away.

All of that was just part of “Phase One” of the massive surgical construction project. “Phase Two” included the opening of Florida’s first dedicated orthopedic hospital, a massive inpatient and outpatient facility that features 10 more ORs, 75 inpatient smart rooms and a bioskills lab.

All told, the two phases completed the opening of the 375,000-square-foot Orlando Health Jewett Orthopedic Institute, a seven-story medical facility in downtown Orlando designed to handle any orthopedic need a patient could possibly have. The project leaned on the expertise of a variety of providers with the goal of providing patients access to anything they may require for treatment.

“As surgeons, we often get questions about what the operating room looks like, and the technology we utilize during each procedure,” says Michael Jablonski, MD, Orlando Health Jewett Orthopedic Institute’s physician president, in a recent article on the opening of facility in the publication State of Reform. “We included physicians, nurses and other medical professionals in the planning of this project, which led to unique touches that will benefit our patients and help ease anxiety before surgery.”

The massive project is yet another example of how the orthopedic specialty can develop comprehensive standalone facilities that relieve surgical patients from needing to interact with traditional inpatient hospitals entirely.

As specialties expand in the ambulatory market, especially orthopedics, creating state-of-the-art facilities and making upgrades are critical to success.

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When you’re looking to build or grow your ASC, we’ll guide you through the business challenges so you can dedicate your full focus on patient care. Because you want the best outcomes for your patients, we uncover to the best solution—and get you what you need, right when you need it most.

The growth in ambulatory surgery centers (ASCs) across the country is undeniable as the healthcare world continues to evolve post-pandemic with more complex surgeries moving from the hospital setting to the outpatient environment. A large area of change is in the orthopedic sector as total joints and spine surgeries are offered in more centers as renovations and new builds take place. As these new ambulatory centers come online, the communities they serve are enhanced with safe patient surgery at a lower cost.¹

The leaders in ambulatory surgery, state by state, have focused on the future with these renovations and new builds as they anticipate the increased need for same-day surgery as the population ages. Taking the journey to create state-of-the-art ORs and welcoming facilities requires a skilled partner and collaboration to encompass the requirements of multiple stakeholders.

As procedures continue to migrate from the hospital outpatient department to ASCs, there is the potential to save more than $55 billion in annual healthcare costs. Today’s ambulatory surgery leaders are taking on the challenge to expand their businesses, prepare for the future and take advantage of collaborative partners, such as Stryker, to achieve their goals.

Stryker has deep experience in the evolving ASC market, understands the challenges of these facilities and has delivered tailored solutions to hundreds of centers. Since every ASC is unique, with its own special blend of clinical, operational and financial circumstances, the need for customization throughout the critical growth process is key. In fact, Stryker offers a customized partnership with a dedicated team who starts by listening and learning about each ASC’s situation and future needs. Instead of selling a pre-determined solution, Stryker tailors a unique solution that will deliver an exceptional experience for ASC owners.

The process involves not only the logistics of creating a new space or center, but also the capital equipment requirements of the facility – and that deserves a careful look. Stryker’s customizable agreements, for example, allow facilities to acquire the capital equipment when it is needed. They also offer financial and marketing support long after the facility is open to ensure success.

Whether planning a new build or expansion or adding a sub-specialty, Stryker can help navigate these steps with a comprehensive solution to address individual challenges and help plan for strategic growth. In the last 30 years, Stryker has helped design and outfit over 15,000 operating rooms, and offers a broad product portfolio that has the right equipment for every part of an ASC.

Just one example of this partnership with Stryker is the Lighthouse Surgery Center in Hartford, CT, a state-of-the-art Ambulatory Orthopedic & Spine Surgery Center designed for comprehensive outpatient surgical procedures and specializing in surgery for joint replacement, sports-related injuries and the spine.

“The biggest advantage of Stryker was the fact that they were flexible. They were also very in tune to our creativity….They were eager to listen to our ideas and our concepts. And they made it work. We got what we wanted, which was all about high quality care for the patients.” says Christine Jackson, Executive Director of Lighthouse Surgery Center.

Note: for more information go to Ambulatory Surgery Center (ASC) | Stryker and Build your ASC | Stryker

References:
1. “Staking Your Claim in the Ortho Space,” Outpatient Surgery Magazine, July 2023; Article | Outpatient Surgery Magazine (aorn.org)