First the Centers for Medicare & Medicaid Services (CMS) wanted to remove a large number of services from its inpatient-only list, now it wants to add them back on—to the consternation of physicians in ambulatory surgery centers.
CMS Flip Flopping Over ASC Rules Has Doctors Frustrated
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Specifically, CMS is proposing to reverse changes to the inpatient-only list in its Calendar Year 2022 Hospital Outpatient Prospective Payment System and ASC (Ambulatory Surgery Center) Payment System Proposed Rule.
The inpatient-only list defines the list of services that Medicare will only pay for when performed in the inpatient setting. Last year, CMS had “finalized a policy to eliminate the IPO [inpatient only] list over a three-year period, removing 298 services from the IPO list in the first phase of the elimination.”
However, widespread public reaction, said the agency, “opposed the elimination of the IPO list primarily due to patient safety concerns, stating that the IPO list serves as an important programmatic safeguard.”
As a result, the newest proposed rule now recommends a stop to the elimination of the inpatient only list. The proposed rule plans “to add the 298 services removed from the IPO list in CY [calendar year] 2021 back to the IPO list beginning in CY 2022.”
In an Ambulatory Surgery Center Association (ASCA) press release, ASCA CEO Bill Prentice said, “The decisions by CMS over the past two years to add and remove hundreds of provisions from both the inpatient-only and ambulatory surgery center payable lists have been jarring—clinicians deserve a better system for advising them on which settings they can use to provide care for Medicare beneficiaries.”
Prentice continued, “We hope that a clear process can be codified to allow clinicians to submit data on procedures that they believe can be safely performed in the ASC and to assure transparent decision-making by the agency in response.”
The proposed rule is available online. Comments on the 2022 proposed rule can be submitted to CMS through September 17, 2021.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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