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Medicare Information for 2018 and beyond - USA Patients

Discussion in 'Hip Replacement Pre-Op Area' started by Jamie, May 4, 2015.

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  1. Jamie

    Jamie ADMINISTRATOR Administrator
    Thread Starter

    Member Since:
    Mar 24, 2008
    United States United States
    Changes are scheduled for 2018 in the way Medicare provides coverage for surgical procedures including joint replacement surgery.

    Currently surgery covered under Medicare provides a "bundled" payment for the entire procedure to the surgeon. The bundle includes visits by the surgeon while in the hospital, discharge, and post-op visits. For example, a knee replacement pays for 3 in-hospital visits, the discharge and 3 visits after surgery within the 90 day period from surgery forward (called the 90-day global period).

    Beginning in 2018, the global period will change to zero (0), meaning that payments will not cover any post-op visits in the surgery payment package, essentially unbundling the payment process for Medicare patients. The reason for this change is the government auditors determined that the number of post operative visits to doctors was consistently below the three visits paid for in the bundling process.

    So what might this mean for patients contemplating joint replacement surgery and the surgeons performing the procedures? For patients, there probably will be no direct impact as their needed post-op visits should be covered as an individual cost. But most certainly the surgeons will receive smaller payments for the surgery overall from Medicare. Assuming that 1 or 2 post-op visits are needed for an average case instead of the three now allowed under the bundled payment program, there will be less money going to your doctor.

    It remains to be seen if this reduction in payments will impact how surgeons handle post-op care or if the reduction will impact the number of surgeons who perform joint replacement and other surgeries. So far there has not been much discussion of this issue, but as the deadline nears it should become more of a topic for discussion in the medical community.

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