American Association of Hip and Knee Surgeons

Advocacy, Education, Research

Practice Management

AAHKS Position Statement on TKA Removal from the Inpatient Only List

In November 2017, the Center for Medicare and Medicaid Services (CMS) finalized the 2018 Medicare Outpatient Prospective Payment System rule that removed total knee arthroplasty (TKA) procedures from the Medicare inpatient-only (IPO) list of procedures. This action has already had significant and unexpected consequences.

Unfortunately, the unintended consequence of this change has been an unprecedented amount of confusion on the part of a variety of stakeholders regarding how to interpret this new rule. Although TKA has been taken off the IPO list, it is reasonable to expect that the vast majority of patients should be treated, by default, as qualifying for inpatient designation. AAHKS has issued a Position Statement to guide members and their institutions on this issue. Read the Position Statement, and review additional resources. 

AAHKS Position Statement on CDC Guideline Use of Antibiotics

The Centers for Disease Control and Prevention (CDC) released their 2017 Guideline for the Prevention of Surgical Site Infection, which recommends against the use of post-operative prophylactic antibiotics – including patients undergoing total joint arthroplasty (TJA). Full statement.

Quality Payment Program (QPP)/MACRA Payment Resources

With the repeal of the Sustainable Growth Rate (SGR) system, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). On October 14, 2016, CMS released the final rule implementing the new Medicare physician Quality Payment Program (QPP) as authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP incentivizes quality physician services through the Merit-based Incentive Payment System (MIPS) which adjusts Medicare reimbursement beginning in 2019 based on physician performance measured in 2017 and beyond. Physicians may be exempted from MIPS adjustments and may receive a bonus payment for participating in CMS-approved Advanced Alternative Payment Models (Advanced APMs). CMS made significant changes from the proposed rule. Learn more.

Cigna/eviCore Pre-Certification Resources

Cigna (through eviCore) has implemented a pre-certification process for total joint arthroplasty patients. AAHKS President Jay R. Lieberman MD, and AAHKS Executive Director Mike Zarski met with the leadership of Cigna and eviCore to review concerns with this process. The AAOS also had representatives at the meeting. AAHKS and AAOS expressed concerns with a number of procedural and clinical aspects of the pre-certification process. At that meeting, it was agreed there would be a follow-up conference call to address any problems encountered with the pre-cert process after the official roll-out.

If your staff has problems getting cases approved in a timely fashion, it is essential that that you make this clear to eviCore and Cigna. It is also essential that you inform AAHKS about your experience with the Cigna precertification program both good and bad, but especially denials or delays in authorization. AAHKS will then review this data with Cigna in late February or early March.

Please contact Josh Kerr, Director of Advocacy and International Activities, at AAHKS about your experience with Cigna or if you have any questions regarding this process at or (847) 698-1200.

To access the Cigna/EviCore approval process, visit or call 888-693-3297.

Visit the AAHKS ICD-10 Resource Center

AAHKS has compiled resources to assist physicians and their staff with ICD-10 transition. Full details.

Primer on Orthopedic Risk Stratification and Comorbidity Coding

The AAHKS Risk Adjustment Task Force has been working with CMS and the Yale Outcomes Group to improve the risk adjustment models used in TJA performance measures. We are seeking your help in systematically capturing the risk variables known to influence outcomes, and have developed an easy to use checklist to help record the data. Full details.

Reports from AMA Meeting Delegates

2015 AMA Interim Meeting
AMA Delegate Chris J. Dangles, MD and Joshua Kerr, AAHKS Director of Advocacy and International Activities, attended the AMA Interim Meeting in Atlanta and submitted this report.

2015 AMA Annual Meeting
Courtland G. Lewis, MD ended his term as delegate and chaired the Reference Committee G on Medical Practice at the 2015 Annual Meeting of the American Medical Association. Read the report.

Patient Risk Calculator for Surgeons

AJRR has developed this risk calculator for orthopaedic surgeons to use when advising Medicare-eligible patients (65 years or older) on their individual risk of poor outcomes for total hip and knee surgery.