Aug 1, 2019

Medicare proposes outpatient hip replacements

Hip Prosthesis, Surgery X-rays. Photo: BSIP/Universal Images Group via Getty Images

Medicare is proposing to start paying for total hip replacement surgeries in outpatient surgery centers next year, meaning patients can go home the same day they get the procedure instead of having to stay overnight in a hospital.

Why it matters: Medicare spent roughly $6.5 billion on hospitalizations tied to hip and knee replacements in 2016. There’s a push to move more of those costly procedures into surgery centers because patients could recover at home and it’s cheaper to do as an outpatient.

Between the lines: Many patients with commercial insurance get new hips and knees in surgery centers instead of hospitals. Medicare started allowing knee replacements to occur in outpatient centers in 2018, and officials have contemplated doing the same with hip replacements since then — so this was just a matter of time.

  • Hospitals aren’t thrilled about this shift because these surgeries are more lucrative in the inpatient setting. 
  • There’s also concern about whether Medicare patients, who usually are older and more frail, need extra recovery time before going home.

Yes, but: Surgery centers and orthopedic surgeons naturally love this because they’ll get a ton of new Medicare patients, and the revenue that comes along with it.

  • And hospitals have been hedging this trend for years by acquiring orthopedic surgery centers and physician groups.

Go deeper: Hospital joint replacement prices are all over the board

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Medicare sets higher hospital pay for 2020

Photo: ATU Images/Getty Images

The federal government approved a 3% all-in pay bump for Medicare’s inpatient services in 2020, equating to $3.8 billion in additional funding to hospitals.

The bottom line: Even though the final raise is down from the proposed regulation (which would’ve raised Medicare inpatient spending by $4.7 billion), this is one of the most generous rules hospitals have seen in years, as mandated cuts from the Affordable Care Act are phasing out.

Go deeperArrowAug 6, 2019

Health care industry kills cuts to heart pump payments

Doctors conduct a heart procedure. Photo: Jeff Gritchen/Digital First Media/Orange County Register via Getty Images

Hospitals, doctors and medical device companies have successfully lobbied Medicare to abandon a proposed 30% cut in payments for certain surgeries involving heart pumps.

Why it matters: Regulators attempted to rein in spending on a powerful and well-financed niche, but the industry managed to preserve its payments yet again.

Go deeperArrowAug 13, 2019

Medicare will now cover a costly cell therapy for cancer patients

A lab tech handles a CliniMACS Prodigy automated device used for cell processing. Chimeric antigen receptor (CAR) T-cell therapy has been hailed as a major advance in clinical cancer care. Photo: GERARD JULIEN/AFP/Getty Images

The Centers for Medicare & Medicaid Services announced yesterday that Medicare will cover the innovative but expensive cancer treatment CAR-T, providing "consistent and predictable patient access nationwide," CMS administrator Seema Verma said.

By the numbers: The treatment, which is customized for each individual patient, costs $375,000 or $475,000, depending on the type of cancer, the Washington Post notes. The overall cost can rise by hundreds of thousands of dollars when hospital stays are factored in.

Go deeperArrowAug 8, 2019