Uncle Sam Proposes Raising Ortho Payments 1.8% in 2019

CMS (Centers for Medicare and Medicaid Services) has issued its Proposed Rule for the Fiscal Year 2019 Inpatient Prospective Payment System (IPPS).

This is the amount of money the government intends to pay for medical services starting October 2018 for operating and capital-related costs of acute care hospitals.

It looks like artificial disc replacements are the orthopedic winners this year with a proposed 8.9% rate increase.

Larry Biegelsen and his team of analysts at Wells Fargo Securities looked at prospective payments for orthopedic procedures and reported a 1.8% increase for orthopedic procedures from the 2018 payment schedule.

Specifically, extremities will be up 2.8%, spinal fusion will increase by 1.6% and trauma will go down 0.3%.

In the extremities sub-category, reimbursements will rise 4.0% for lower extremities procedures and up 1.5% for upper extremities.

In the spine fusion sub-category, cervical discs will rise the most at 8.0% and lumbar/thoracic up by 3.1%. Those increases are offset by a 3.4% decline in combined anterior/posterior fusions and non-cervical procedures with malignancy down 1.1%. Artificial disc reimbursement will go up that whopping 8.9% while vertebroplasty/kyphoplasty rises by 1.8%.

The news for hip and knee replacement was not good, with a proposal to cut reimbursements by 0.5%.

To dig into the 1,883-page proposed rule on the official CMS home page, click here.

These are the proposed rates. If you want to comment, you’ve got until 5 p.m. on June 25, 2018 to submit your comments.