CMS proposes Medicare coverage for outpatient joint replacements, changes to SNF 3-day stay rule
Emily Mongan, Staff Writer/July 17, 2017
The Centers for Medicare & Medicaid Services released two proposals last week that may change where beneficiaries receive joint replacements, and how accountable care organizations deal with the agency’s three-day stay rule waiver.
The first proposal, contained within a proposed rule concerning hospital outpatient prospective payments, would allow Medicare to cover knee replacement surgeries in outpatient facilities.
Research on conducting the procedures in outpatient settings has shown outpatients did not experience higher complication or readmission rates than inpatients, CMS said. If the rule were to be enacted, beneficiaries would still be able to undergo the procedures in an inpatient setting “based on the beneficiary’s individual clinical needs and preferences,” the agency said.
CMS also is soliciting public comment on possibly doing the same with hip replacements.
