CMS Proposes Value-Based Payments for Hip, Knee Replacements July 10, 2015 Medicare, Payment CMS, knee and hip replacement, value-based payment 0 CMS has proposed significant changes to Medicare reimbursements for knee and hip replacements. According to CMS, more than 400,000 inpatient knee and hip replacements were covered by Medicare in 2013, accounting for $7 billion in hospitalization costs. Providers currently are reimbursed for hip and knee replacements under a fee-for-service system. The procedures—including hospitalization, surgery and recovery—can cost $16,500 to $33,000, depending on the region. In addition, the quality of the procedures varies significantly, with complication rates that can be more than three times higher at some hospitals than at others. The proposed changes would base such reimbursements on quality. Providers would receive one flat fee for the procedures instead of receiving multiple payments for each individual service they provide related to the replacements. The proposal also would allow Medicare to give providers extra payments for positive patient outcomes. Further, the plan would incentivize hospitals to work with home health agencies, nursing homes and physicians to ensure patients are receiving necessary coordinated care, which could reduce avoidable readmissions and complications. The proposal also would require providers to repay part of their reimbursements for the procedures if patients contract infections or other complications that could have been avoided. About $2.2 billion in Medicare spending would be used in the program in 2016. That amount likely would grow to $2.7 billion in 2020. Federal officials estimate the revisions would save about $153 million over the five-year period. SFMS encourages all interested parties to submit comments electronically through the CMS e-Regulation website or on paper by following the instructions included in the proposed rule. Submissions must be received by September 8, 2015. Click here to view the CMS announcement. Click here to view the complete 439-page proposed rule. Comments are closed.
