Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill
Kaiser Health News interviews experts including Catherine MacLean, MD, PhD, chief value medical officer at HSS, about the Centers for Medicare (CMS) decision to eliminate the inpatient-only procedures list.
CMS is phasing out the list over the next three years. On January 1, 2021, 266 shoulder, spine and other musculoskeletal surgeries were crossed off the “inpatient-only list.” By the end of 2023, the list — which includes a variety of complicated procedures including brain and heart operations — is scheduled to be gone.
The decision was part of the Hospital Outpatient Prospective Payment System Final Rule. CMS officials said the change was designed to give patients and doctors more options and help lower costs by promoting more competition among hospitals and independent ambulatory surgical centers. While removing the surgeries from the inpatient-only list, the government did not approve them to be performed anywhere else. Patients will still have to get the care at hospitals. But because the procedures have been reclassified, patients who have them in the hospital don’t have to be considered admitted patients. Instead, they can receive services on an outpatient basis.
CMS should have tested the change as a pilot project to be sure it’s safe for patients, noted Dr. MacLean. “These are big procedures,” she said, involving a lot of “cutting, sewing and bleeding” that require post-surgery monitoring due to a significant risk of complications, especially for patients with multiple health problems.