February 1997 AAOS Report

HCFA demonstration project will affect quality of care

The Health Care Financing Administration's (HCFA) "participating centers of excellence" program to reduce the cost of hip and knee replacements for Medicare patients will come at the expense of quality care, William W. Tipton Jr., MD, Academy executive vice president, said in a news release last month. "The Academy is strongly opposed to the use of the term 'participating centers of excellence' because it is a marketing ploy that will mislead patients into believing these are the only hospitals that can provide quality service," Dr. Tipton said. "This is not true." HCFA notified 152 institutions on Dec. 20, 1996 that they can submit final applications for the program. There were 84 institutions for orthopaedic services and 68 for cardiovascular services.

Bernard F. Morrey, MD, chairman of the department of orthopaedic surgery at Mayo Clinic, Rochester, Minn., said Mayo will not participate in the program. "HCFA's final application form made it crystal clear that the primary focus of HCFA is discounts," Dr. Morrey said. "In no appreciable way does the process encourage or reward quality service. HCFA only wants to discount further what, in our opinion, is already being discounted in a manner that compromises patient care. HCFA's application made it clear that if you don't show a discount in costs, don't apply. It appears to only pay lip service to quality." Dr. Morrey also pointed out that Mayo's orthopaedic service performs a high percentage of joint reoperations. "The reimbursement for a reoperation is at the same rate as the primary operation, despite the fact that the cost of the implants are higher, the operating time is longer, the in-hospital stay is longer and the complication rate is higher. Mayo's revision practice is increasing and the negative reimbursement is becoming prohibitive. Unfortunately, HCFA has missed or ignored the opportunity to rectify this inequity which ultimately will have a severe negative impact on patient care and access.

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