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Adding Total Shoulder Replacements to the ASC-Payable List

In a recent CMS final rule, 11 procedures, including total shoulder arthroplasty, secured a spot on the ASC-covered list, a surprising addition not initially outlined in the proposed rule.

The Ambulatory Surgery Center Association's CEO and Director of Government Affairs and Regulatory Counsel detailed this journey in an episode of the Advancing Surgical Care Podcast. According to the ASCA, the inclusion of total shoulder arthroscopy resulted from a substantial advocacy effort by the association and its members.

ASCA's Pivotal Role in Shaping Policy

The shift from the proposed rule to the final rule was significant, as highlighted by the ASCA CEO. Expressing concern about the evolving philosophies of medical directors in previous years, the ASCA played a crucial role in influencing this change.

During discussions with CMS, the ASCA team, led by Kara Newbury, presented compelling data from ASCA members, Medicare, and private payers, emphasizing the safety of outpatient total shoulder and total ankle procedures. The positive response from members indicates the potential impact on practices, with physicians expressing excitement about dedicating entire days to total shoulder procedures at surgery centers.

While there are still numerous codes approved for hospital outpatient departments but not ASCs, Newbury expects a continued "piecemeal" approach. The ASCA will strategically target specific procedures annually rather than an immediate, across-the-board expansion of ASC-payable codes.

In navigating these changes, the ASCA remains vigilant, anticipating further opportunities to advocate for ASC inclusion in the evolving landscape of outpatient procedures.

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