Recently, the Centers for Medicare and Medicaid Services implemented a rule requiring providers to accept bundled prices for joint replacements. Medicare only covers joint replacements performed inpatient. Modern Healthcare reports on a new trend toward performing joint replacements in outpatient facilities at a lower cost.
The Ambulatory Surgery Center Association says close to 40 centers around the country are performing outpatient joint replacements, and outpatient surgery companies such as Surgical Care Affiliates are aiming to increase them.The new Medicare pricing law, MACRA, is pushing Medicare providers to use population based and episode based payment methods. Modern Healthcare is reporting that the accountable care organization ("ACO") industry is complaining over the fact that HHS's proposed MACRA rules does not consider a "low risk" ACO to be one of these acceptable alternative payment method. MACRA is pushing Medicare providers to use population based and episode based payment methods.
Moving these procedures to outpatient settings poses a major threat to hospital finances, since total joint replacements are one of the largest and most profitable service lines at many hospitals. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing the government more than $7 billion for the hospitalizations alone—over $50,000 per case. The financial threat will be even greater if the CMS changes its rules and allows Medicare and Medicaid payment for these outpatient procedures, which observers expect will happen in the next few years.
ACOs are extremely concerned about the direction the CMS is going not only in the proposed MACRA rules but also with the conflicts created by its other value-based payment programs such as bundled payment," NAACOS [ACO trade association] President and CEO Clif Gaus said in a statement. "And when you add that to how much it costs to run an ACO, there's a significant number of ACOs ready to leave the [Medicare Shared Savings Program].According to Healthcare Dive, population health experts are concerned over a report that the U.S. death rate rose in 2015 for the first time in a decade. "The increase came largely from higher rates of drug overdoses, suicide and Alzheimer’s disease, with a slight increase in heart disease, The New York Times reported." The FEHBlog recalls the AMA President Steven Stack saying during a speech that heart diseases is a default cause of death in America.