CMS to Raise Ankle Bundle Reimbursement

In September, an update to CMS’s Inpatient Prospective Payment System increased the reimbursement bundle for primary and revision total ankle replacement procedures. The change will begin at the start of the 2018 fiscal year and will “move total ankle replacement from a broad, lower-paying joint category that includes total hip and total knee replacement that yielded thin margins and lower utilization into a higher-paying Medicare code, “ says Greg Berlet, MD, Orthopedic Foot and Ankle Center in Columbus, Ohio.

Berlet further explains that, “this announcement and change is most significant on the facility level, not the provider level and it also doesn’t apply to outpatient centers. The change reflects that people who are changing the regulations are hearing us.”

The alternative surgical option to replacement, ankle fusion, is a good option for pain relief for such patients, but replacement ideally restores functionality of the joint, while fusion generally reduces joint function. Berlet says the update is needed because knee replacements by comparison are more predictable, and usually needed because of normal wear and tear and age. Ankle replacement, by contrast, is more complex, requires longer operative times, and may need other work such as ligament repair that is uncommon in knee replacements.

Berlet believes the business impact of the decision is that hospitals will be much more willing to embrace total ankle replacement in their musculoskeletal service line, and be more willing to partner with physicians. He further expects the reimbursement decision to remove the financial barriers in place when accessing ankle replacement.

“Executives should make sure they surround themselves with physicians who embrace this innovation and can bring this skill to their facility,” he says. “They will find a rewarding service line to invest in.”

The opinions of Philip Betbeze and Dr. Greg Berlet are theirs alone and do not necessarily reflect the opinions of Wright Medical.