Orthopedic Surgeons Unhappy With CMS Physician Fee Changes

The Centers for Medicare and Medicaid Services (CMS) is emphasizing high-quality care and efficiency in its 2014 Medicare Physician Fee Schedule, but the plan is becoming increasingly unpopular with the nation’s orthopedic surgeons.

While primary care doctors will be reimbursed for chronic care management services outside of face-to-face visits beginning in 2015, the agency reduced fees for total hip and knee replacements — a move orthopedic surgeons believe will further limit patient access to such procedures.

“Healthcare is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes,” CMS Principal Deputy Administrator Jonathan Blum said in a written statement. “We believe that successful efforts to improve chronic care management for patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits.”

The rules allow payments for telehealth services in rural regions that qualify as health professional shortage areas. A change to the Physician Quality Reporting System (PQRS) gives eligible physicians the option to report quality measures through qualified clinical data registries.

CMS estimates that approximately $87 billion will be paid to physicians under the 2014 fee schedule.

But it also maintains the sustainable growth rate pay cuts, which has prompted forceful pushback from physician groups, including the American Medical Association (AMA) and the American Academy of Family Physicians. The American Academy of Orthopaedic Surgeons (AAOS) is displeased with the fee schedule as well, particularly the 11 percent slide in relative value units (RVU) for total knee arthroplasty and 5 percent decrease in total hip arthroplasty RVUs.

“Although we are disappointed with the devaluation of procedures that we know provide tremendous value to the individual patient and to society, and that CMS did not use the values recommended by AAOS and AAHKS,” AAOS President Joshua J. Jacobs, M.D., said, “we are pleased that CMS responded to our extensive regulatory and legislative advocacy efforts to alter the RUC’s [RelativeValue Update Committee] recommendation of far deeper cuts. AAOS and AAHKS continue to strongly believe the AAOS/AAHKS recommended values are the correct RVUs for these procedures.”

Both AAOS and the American Association of Hip and Knee Surgeons (AAHKS) contend the government’s survey methodology is an invalid statistical measurement that produces flawed data. Health economists and other experts also object to the reliance on survey data, and even Congress — in draft legislation to replace the sustainable growth rate formula — has directed CMS to investigate more reliable sources of time.

CMS’s own data collected on anesthesia time for hip and knee surgeries as well as femur fractures indicate that procedures times for total hip arthroplasty and total knee arthroplasty did not significantly change between 2005 and 2012.

AAOS and AAHKS recommended that CMS and the American Medical Association’s Multi-Specialty Relative Value Update Committee (RUC) leave work RVUs for THA unchanged and decrease work RVUs for TKA by 4 percent. Although the RUC rejected the AAOS’s recommendations, CMS officials acknowledged the input from specialty societies and moderated the RUC’s recommendations to somewhat minimize the decrease.

The new values take effect Jan. 1.