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CMS may alter this policy for CY 2019 and seeks to explore policies to address the needs of safety net hospitals.
CMS expects this policy will allow for redistribution of the estimated $1.6 billion decrease in drug payments to non-drug items and services across OPPS to ensure that implementation is budget neutral.
This year, CMS finalized a policy to remove total knee arthroplasty (TKA) from the Medicare IPO for procedures reimbursed only under IPPS.
This move will allow Medicare to reimburse TKAs performed on an outpatient basis, likely resulting in a shift of thousands of procedures from inpatient to outpatient.
This change to Medicare drug payment policy is both significant and controversial.