CMS’s plan to phase out inpatient-only list could bolster rural ASCs

Editor's Note

The proposal from the Centers for Medicare & Medicaid Services (CMS) to eliminate the Medicare Inpatient Only (IPO) list over 3 years could significantly expand opportunities for ambulatory surgery centers (ASCs), with rural facilities among those positioned to benefit most, Ambulatory Surgery Center News August 12 reports. The IPO list determines which procedures Medicare will only cover in inpatient settings, and its removal would open the door for higher-acuity, higher-margin surgical procedures to move into outpatient care.

As detailed in the article, rural ASC leaders see the change as a chance to keep more patients local while broadening surgical offerings. “We’re already doing some higher-acuity procedures here anyway,” said Linda Bedwell, CEO of ASCend Specialists, who emphasized that eligible cases will still be limited to patients healthy enough for outpatient surgery and discharge home.

However, the financial viability of these newly eligible procedures remains a concern. Bedwell noted some surgeries could cost centers more to perform than they are reimbursed, requiring careful review of payer contracts. She added that commercial negotiations can be as challenging as Medicare, with fewer direct channels to decision-makers at large insurers.

The proposal also highlights the need for stronger advocacy, Bedwell said, stressing that ASC operators must engage legislators to ensure outpatient perspectives are considered in policy decisions. Collaboration with hospitals will also be essential, particularly in rural regions where relationships between the two settings can be strained. “I think we could have a little bit more cohesiveness between the rural healthcare hospitals and surgery centers,” she said, noting that partnerships could help both succeed.

For states like Wyoming, where about 20 ASCs and a handful of hospitals serve a sparse population, the expanded procedure list could keep ASCs operating at capacity. While Bedwell does not expect the IPO phase-out to create a surge in new rural ASCs, she said it could help existing centers run at full capacity while still maintaining efficiency.