We’ve all heard the old joke: What are the three most important factors to consider when investing in real estate?
Location, location, location.
But who would have thought that the same would apply to surgical scheduling and reimbursement?
Making the cut…or not
The Inpatient Only (IPO) List was created back in 2000 with the aim of identifying surgical procedures that require inpatient stays for Medicare reimbursement. The list, which is adjusted annually, currently covers over 1,700 procedures.
But abruptly, in 2020 – and absent any clear criteria – the Centers for Medicare & Medicaid (CMS) announced the list would be phased out starting in 2021 and eliminated entirely by 2024. That was the plan announced last year, but as is so often the case, plans change. This year (2021) CMS did an about face after receiving significant feedback from multiple stakeholders who voiced concerns over scrapping the list. While nothing has been finalized, it appears the IPO List is back.
Executive brief excerpt
For providers, this development has implications for three main areas of clinical practice and operations:
- Reimbursement: If a provider completes an IPO procedure in an outpatient setting, they may lose reimbursement for that procedure and all other services related to that surgery.
- Scheduling and workflows: If a surgery is booked as an outpatient procedure when it should have been scheduled for an inpatient site, it could have repercussions for the entire perioperative workflow.
- Patient safety and care quality: As CMS noted in its explanation for why it was returning to the IPO List, many stakeholders feel that the list “serves as an important programmatic safeguard.” While others argue they should be permitted to rely on their clinical judgement to determine where procedures should take place, the list guarantees everyone is on the same page when it comes to following best practice guidelines.