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The Centers of Medicare and Medicaid Services (CMS) recently announced a directive to relax the requirement that surgeries for Medicare beneficiaries be performed only on an inpatient basis to qualify for reimbursement. Starting January 1, 2022, more than 250 musculoskeletal surgeries will be eliminated from the “inpatient-only list,” with an additional 1,500 surgeries eliminated in the following year. CMS contends that the directive, a continuation of previous cost-saving efforts, provides more flexibility for patients and physicians, lowers costs, and promotes competition between hospital and independently owned ambulatory surgical centers (ASCs).
The directive has additional benefits by allowing more surgeries to be performed in facilities that do not treat patients with infectious diseases and leveraging enhanced recovery procedures that enable discharges from surgeries to occur sooner. ASCs will become legitimized as the “right place for the right care” for the many surgeries with low likelihood of complications. CMS, however, gets only partial credit for its directive since it failed to also change its reimbursement practices. This omission could cause many hospitals, surgical practices, and patients to prefer in-hospital to ASC-based surgeries, even when ASCs are the most clinically appropriate setting. CMS can remedy this gap by addressing underlying policies that are driving the reimbursement differences.