How total shoulder replacements got added to the ASC-payable list

In its final rule, CMS added 11 procedures to the ASC-covered list that were not included in the proposed rule, including total shoulder arthroplasty. 

Bill Prentice, CEO of the Ambulatory Surgery Center Association, and Kara Newbury, the organization's director of government affairs and regulatory counsel, laid out the association's journey in getting those procedures added in an episode of its Advancing Surgical Care Podcast, released Nov. 15. 

The addition of total shoulder arthroscopy to the list, according to Mr. Prentice, was the "result of the substantial advocacy effort on the part of ASCA and our members."

"I can't overstate what a change this was from the proposed rule to the final rule," Mr. Prentice said on the podcast. "... For the last couple of years, we were very concerned that the medical directors were actually moving in the opposite direction with some of their philosophies."

In meetings with CMS, Ms. Newbury and the ASCA team presented data from ASCA members, Medicare and private payers on the safety of performing outpatient total shoulder and total ankle procedures. 

"We've already been hearing from our members saying how excited their doctors are, and how they're going to be able to fill up an entire day now at a surgery center doing total shoulders and it's really going to help with their practice," Ms. Newbury said. 

While there are still hundreds of codes CMS has approved for hospital outpatient departments but not ASCs, Ms. Newbury said she expects this process to remain a "piecemeal" strategy where the ASCA is "strategically targeting certain procedures every year." 

"I don't think anytime soon we're just gonna see them automatically allow anything that is payable in the hospital outpatient department setting to also be payable in the ASC," she said.

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