REGULATORY REVIEW


knew ASCs were doing that were cur- rently on the IPO list.


2013 and 2014: ASCA held two meetings with CMS staff specifically to discuss the addition of spine codes to the ASC-payable list. The meeting in 2013 took place after the proposed rule was released. Adding codes between the proposed and final rules is typically more difficult than add- ing them when CMS proposes them for addition from the beginning. In 2014, we met with CMS staff earlier in the spring, and our efforts were rewarded with spine codes being included in the 2015 proposed rule. Heeding the warnings from when TKA was proposed for removal in 2013 but not finalized due to a neg- ative public response, ASCA called upon its members to provide posi- tive feedback to CMS regarding the volume and outcomes of these spine codes being done in their facili- ties. As a result, CMS finalized nine spine codes in the 2015 OPPS/ASC final rule.


2015: Although our efforts were fruit- ful in 2014, we did not get all the spine codes we had requested added to the ASC-payable list. In 2015, we went back to CMS to discuss other spine codes that should be payable in ASCs. Due in large part to ASCA advocacy, there were 17 codes added to the ASC-payable list for 2016, most of them spine codes.


In addition, we presented on total joint procedures being performed in the ASC setting. While we knew there was little appetite for CMS to move total joints off the IPO list due to the backlash the agency received previously, it was important to lay the groundwork for the movement of these codes.


2016: In 2016, ASCA focused its efforts on total joints, starting with TKA since CMS previously showed


22 ASC FOCUS MAY 2020 | ascfocus.org


an interest in moving that code off the IPO list. In January 2016, an ASCA orthopedic surgeon met with CMS to present outcomes data for TKA and total hip arthroplasty (THA). In addition, in August 2016, an ASCA member surgeon presented to the Advisory Panel on Hospital Outpatient Payment (HOP Panel) on the safety and efficacy of TKA being done in the ASC setting. The HOP Panel advises the secretary


of


the US Department of Health and Human Services (HHS) and the CMS administrator on strategies for addressing issues related to the clini- cal integrity of procedures within the OPPS, including “removing proce- dures from the inpatient list for pay- ment under the OPPS payment sys- tem.” After that presentation, the HOP Panel unanimously recom- mended that CMS remove TKA from its IPO list. While the HOP Panel’s recommendations are not binding, it is helpful to have this body support the movement of this code to the out- patient setting. In the 2017 proposed rule, released in July 2016, CMS


sought public comments on whether TKA should be removed from the inpatient-only list. While CMS did not take any action on this proposal, the agency indicated in the final rule that the majority of the feedback received was positive.


2017: In the 2018 proposed rule, CMS proposed the removal of TKA from the inpatient-only list, citing support from the previous year’s comments in addition to acknowl- edging it had “taken into account the recommendation from the summer 2016 HOP Panel meeting to remove the TKA procedure from the IPO list.” CMS also requested more infor- mation from the public on poten- tially removing THA from the IPO list, but no further action was taken on that procedure. Unlike in 2013 when there was little support, CMS received substantial numbers of pos- itive comments, many from ASCA members as part of the association’s grassroots comment writing cam- paign. CMS finalized the removal of TKA from the IPO list.


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