CMS finalizes policy changes to inpatient-only, ASC-covered procedure lists
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CMS finalized the Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rules, which will take effect on Jan. 1, 2021.
The final rule, which aims to increase value for Medicare beneficiaries, allows CMS to begin eliminating the inpatient-only list beginning with 300 primarily musculoskeletal-related services, according to a press release. The release noted, through this final rule, the inpatient-only list will be completely phased out by 2024.
CMS also announced the addition of 11 procedures to the ASC-covered procedures list, including total hip arthroplasty. Criteria used to add surgical procedures to the ASC-covered procedures list have also been revised, allowing for an additional 267 surgical procedures to be added, the release noted.
“President Trump’s term in office has been marked by an unrelenting drive to level the playing field and boost competition at every turn,” CMS Administrator Seema Verma, said in the release. “Today’s rule is no different. It allows doctors and patients to make decisions about the most appropriate site of care, based on what makes the most sense for the course of treatment and the patient without micromanagement from Washington.”
Perspective
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We recognize CMS’ effort to reduce regulation and offer surgeons more flexibility for individualized decision-making by eliminating the inpatient-only list. While this is a welcome change for those procedures which have been proven to be safely done in the outpatient setting, it is problematic for others that have a higher potential for risk such as acute trauma and amputations. Effectively implementing a change of this magnitude will require that physicians be able to determine the appropriate setting of care, unencumbered by the widespread confusion that has historically resulted from these policies and ultimately delayed treatment for patients.
So, we thank CMS for providing certain exemptions from burdensome medical review by Medicare contractors which allow us to focus on delivering the highest quality of musculoskeletal care without that burden of proof. Now, we are challenged with pioneering this significant shift and refining the clinical guidelines that may aid other specialties as procedures continue to be removed from the list in the years ahead.
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