AAHKS advocacy efforts with the Centers for Medicare & Medicaid Services (CMS) resulted in positive reform on the Alternate Payment Model front. AAHKS worked in an alliance with the American Association of Medical Colleges (AAMC) and the American Academy of Orthopaedic Surgeons to approach CMS about changing the criteria for inclusion of hip fracture patients in the Bundled Payments for Care Improvement (BPCI) initiative. The Centers for Medicare & Medicaid Innovation will be stratifying BPCI target prices within DRGs 469 and 470 to “with fracture” and “without fracture” categories similar to Comprehensive Care for Joint Replacement model’s methodology. This will create four target prices for primary joint instead of two. Implementation of the new methodology is targeted for October 1, 2016.
The NYU Langone Medical Center’s (NYULMC) BPCI implementation group also worked with the AAMC on this issue with Katie Mullaly, MS, RN of NYULMC and Coleen Kivlahan MD, MSPH of the AAMC laying the groundwork for reform with CMS.
Health Policy Council and Advocacy Committee Chair, Richard Iorio, MD, David A. Halsey, MD, AAHKS Health Policy Fellow, Alexander S. McLawhorn, MD, MBA and Douglass E. Padgett, MD, et al co-authored the Frank Stinchfield Award paper, “Total Hip Arthroplasty for Femoral Neck Fracture Is Not a Typical DRG 470: A Propensity-matched Cohort Study” published ahead of print in Clinical Orthopaedics and Related Research this month. The data generated from the paper and multiple meetings with CMS played a role in the CMS’ decision. “We hope that CMS will eventually see the need for risk stratification based on comorbidities and other patient factors for all TJA patients,” said Dr. Iorio.
