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CMS to Raise Ankle Bundle Reimbursement

By Philip Betbeze  
   September 18, 2017

Ankle replacements are usually the result of past injury, thus patients are usually younger, averaging age 55, while knee joint replacement patients’ average age is 70. Given the younger population, Berlet is hopeful commercial insurers will also adjust their reimbursement consistent with the CMS change.

He says 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.

Though many hospitals have said they expect to lose money on Medicare’s Comprehensive Care for Joint Replacement reimbursement model, Berlet doesn’t expect them to experience the same financial difficulty with total ankle replacements.

“I think they’re losing money in hip and knee because they have allocated costs from other service lines,” he says. “I would be more interested if those statements came from orthopedic hospitals, so I don’t buy that statement, but regardless, I believe this can be profitable for everyone and will enhance a hospital’s reputation.”

He says while knee replacements nationwide number between 500,000 and 600,000 procedures a year, ankle replacements represent a much lower number of procedures. Of the 50,000 or so surgeries that feature either ankle fusion or replacement, replacement represents only about a third. This decision will replace fusion in a large number of patients over the next few years, he says.

Berlet says in treatment terms, he expects the decision to remove the financial barriers to access to ankle replacement, and it’s up to hospitals to help remove the accessibility barrier.

“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.”

Philip Betbeze is the senior leadership editor at HealthLeaders.

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