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Health Affairs Blog

The CMS New Rule on Ambulatory Surgical Centers Earns Only Partial Credit

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Abstract

The Centers of Medicare and Medicaid Services (CMS) recently announced that it will be removing more than 250 musculoskeletal surgeries from its “inpatient-only list” in January 2022. An additional 1,500 surgeries will be eliminated in the following year. The change provides more flexibility for patients and physicians, lowers costs, and promotes competition between hospitals and independently owned ambulatory surgical centers (ASCs). It will also allow more surgeries to be performed in facilities that do not treat patients with infectious diseases, legitimizing ASCs as the “right place for the right care” for the many surgeries with low likelihood of complications. CMS, however, failed to change its reimbursement practices in which physicians receive lower fees and patients incur higher co-pays when surgeries are performed in ASCs. This omission will cause many hospitals, surgical practices, and patients to prefer in-hospital to ASC-based surgeries. CMS can remedy this gap by changing historical payment policies that dis-incentivize surgeries performed in ASCs.