CMS proposed rule halts elimination of inpatient only list
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In its Calendar Year 2022 Hospital Outpatient Prospective Payment System Proposed Rule, CMS proposes a halt to its elimination of the inpatient only list, adding the services removed in 2021 back onto the inpatient only list in 2022.
Finalized to occur in a 3-year period, CMS proposed elimination of the inpatient only (IPO) list, and removal of 298 services within the first phase of elimination, in its Calendar Year 2021 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule, according to a press release. However, the release noted CMS received a large number of stakeholder comments throughout the 2021 rule-making cycle and after issuance of the final rule with comment period that opposed the elimination of the IPO list due to patient safety concerns, leading to the proposal to halt that decision.
“This change in policy would ensure that any service removed from the IPO list has been reviewed against Medicare’s longstanding IPO list criteria to determine if it is appropriate for Medicare to pay for the provision of the service in the outpatient setting,” according to the release. “Furthermore, CMS is proposing to codify the longstanding criteria for removal of procedures from the IPO list to make clear in regulatory text how we will evaluate future procedures for removal.”
In addition, CMS is requesting for comments on whether it should maintain the longer-term objective of eliminating the IPO list, or maintaining but continuing to systematically scale the list back so inpatient only designations are consistent with current standards of practice.
In response to this proposal, Daniel K. Guy, MD, FAAOS, president of the American Association of Orthopaedic Surgeons, released a statement that more work is needed to clarify what the changes to the IPO list mean to avoid confusion and unintended consequences for patient care.
“Now as the agency reassesses how it will evaluate future procedures for removal and the longer-term plan for the IPO, it should place more emphasis on physicians leading those decisions and prioritize the value of patient choice,” Guy said in the release. “CMS must also be careful to avoid creating new regulatory barriers to determining the appropriate setting of care as an overcorrection to the policy reversal — especially now after the country has benefited from such flexibilities and individualized medicine during the COVID-19 pandemic.”
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