Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
American Association of Hip and Knee Surgeons, Rosemont, IL.
J Arthroplasty. 2020 Oct;35(10):2772-2778. doi: 10.1016/j.arth.2020.04.079. Epub 2020 Apr 29.
Several studies have shown that the removal of total knee arthroplasty (TKA) from the Centers for Medicare and Medicaid Services (CMS) inpatient-only (IPO) list has caused confusion among surgeons, hospitals, and patients. The purpose of this study is to determine whether similar confusion was present after CMS recently removed total hip arthroplasty (THA) from the IPO list.
We surveyed the American Association of Hip and Knee Surgeons membership via an online web-based questionnaire in February 2020. The 12-question form asked about practice type and the impact that having both THA and TKA removed from the IPO list has had on each surgeon's practice. Responses were tabulated and descriptive statistics of each question reported.
Of the 2847 American Association of Hip and Knee Surgeons members surveyed, 419 responded (14.7% response rate). Three hundred forty-one surgeons (81%) stated that changes to IPO status have increased their practice's administrative burden. Fifty-four percent of surgeons reported that they have needed to obtain preauthorization or appeal a denial of preauthorization for an inpatient total joint arthroplasty at least monthly, while 257 surgeons (61%) have had patients contact their office regarding an unexpected copayment. Despite the commitment of CMS to waiving certain audits for 2 years, 43 respondents (10%) stated they had undergone an audit regarding a patient's inpatient status.
The removal of THA and TKA from the IPO list continues to be an administrative burden for arthroplasty surgeons and a source of confusion among patients. CMS should provide additional guidance to address surgeons' concerns about preauthorization for inpatient stays, unexpected patient copayments, and CMS audits.
多项研究表明，将全膝关节置换术（TKA）从医疗保险和医疗补助服务中心（CMS）仅限住院（IPO）清单中删除，给外科医生、医院和患者带来了困惑。本研究旨在确定 CMS 最近将全髋关节置换术（THA）从 IPO 清单中删除后是否存在类似的困惑。
我们于 2020 年 2 月通过在线网络问卷调查了美国髋关节和膝关节外科医师协会的会员。该 12 个问题的表格询问了实践类型，以及将 THA 和 TKA 均从 IPO 清单中删除对每位外科医生实践的影响。对回复进行了制表，并报告了每个问题的描述性统计数据。
在接受调查的 2847 名美国髋关节和膝关节外科医师协会会员中，有 419 名（14.7%的回复率）做出了回应。341 名外科医生（81%）表示，IPO 状态的变化增加了他们实践的行政负担。54%的外科医生报告说，他们每月至少需要获得一次全关节置换术住院治疗的预授权或对预授权的拒绝进行上诉，而 257 名外科医生（61%）有患者因意外的共同支付费用联系他们的办公室。尽管 CMS 承诺豁免 2 年的某些审计，但仍有 43 名受访者（10%）表示他们已经接受了一次关于患者住院状态的审计。
将 THA 和 TKA 从 IPO 清单中删除继续给关节置换外科医生带来行政负担，并给患者带来困惑。CMS 应提供额外的指导，以解决外科医生对住院预授权、意外患者共同支付费用和 CMS 审计的担忧。
