Medicare Inpatient Only List Explained

Medicare Inpatient Only List Explained. Medicare has a list of approximately 1,800 procedure codes for procedures that it will ONLY pay for on an inpatient basis. These tend to be more invasive surgeries such as a coronary artery bypass graft (CABG).
However, starting in 2021 CMS starting removing procedures from the Inpatient Only List, meaning these procedures can now be paid for on a outpatient basis at an Ambulatory Surgery Center (ASC).
Two of the most important surgeries to come OFF the Inpatient Only List are Total Knee and Total Hip Replacements.
As a result, much of hospital revenue is moving from inpatient to outpatient. Major hospital systems are dramatically growing their ASCs so that competing ASCs do not take their patient volume.
Hospital System Owned ASCs still have very high reimbursement rates from Commercial Insurance for patients on an employer-sponsored health plan. Just because the procedure is at an ASC, that DOES NOT mean it is inexpensive.
Rather for employer-sponsored insurance plans, it is to their advantage to have plan members have outpatient surgery performed at an Independent ASC that is not owned by a major hospital system.
For example, the NTTC ASC in the Dallas Area charges $20,000 as a bundled price for a total knee replacement vs. over $70,000 for the same procedure at a hospital-owned ASC.
Sources:
Medicare Inpatient Only List: www.cms.gov/node/1275841
www.cms.gov/medicare/payment/...
CMS Hospital Outpatient Regulation: www.govinfo.gov/content/pkg/F...
American College of Physician Advisors: www.acpadvisors.org/
HCA ASCs: www.beckersasc.com/asc-news/h...
Tenet ASCs: www.beckershospitalreview.com...
www.beckershospitalreview.com...
www.reuters.com/article/idUSK...
www.nttcsurgerycenter.com/pro...
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[@regularguy428]

Hi Dr. Bricker , I just wanted to say thank you so much for these informative videos. I watch them 3-4 almost weekly. I really appreciate your content.

[@ahealthcarez]

Thank you for watching!!

[@lawron2]

I absolutely love his work 😊.

[@amberriley7600]

Your videos are fantastic. Your delivery reminds me of Lewis Black without the profanity, but I'm also perfectly cool if you decide to take them to NC -17 hahaha, especially when you are emphasizing or trying to emphasize the change impact on something. like say.....removing codes from inpatient only. (hands waving....) Keep it up!!

[@ahealthcarez]

Thank you.

[@SpaghetteMan]

thank you for the explanation! it's surprisingly hard for students to find this kind of information; I don't think any of my professors have ever talked about what happens on the financial side whenever a significant change is made by CMS.

[@ahealthcarez]

Thank you for your comment.

[@lawron2]

I absolutely love these videos. They are so valuable.

[@azppmd]

I appreciate the better audio quality with the lav mic, and attempt at improved voice!

[@ahealthcarez]

Thank you for your feedback.

[@fhd89234n8f43n7]

“Maybe I was just being dense…” 😂
Nope! It’s not you, I have had an incredibly difficult time finding anything in CMS as well. The Data is always there, just really really hard to find.

[@ahealthcarez]

Thank you for your confirmation.

[@liberoAquila]

Physicians should unionize the same way nurses do.

[@ahealthcarez]

Many are. Thank you for your comment.

[@claudioexperience]

Dear Dr. Bricker, well done with the microphone, the audio quality is waaay better now! I would like to have a super quick chat with you, is there any email where I can contact you?

[@drkrheum3937]

Can you drop a video following up on change healthcare? You had a great vid about it before the hack…curious about your thoughts about what happens moving forward.

[@ahealthcarez]

Thank you for your suggestion.

[@amberriley7600]

Okay, do you have a video on the Stark Law also?

[@ahealthcarez]

Yes. Just search AHealthcareZ Stark Law.

[@japeters11]

So many questions...why pay for a list of what's not IPO? Can't we just assume that if it's not on the inpatient only list that it can be done at an ASC? And why would hospitals have to build their own ascs? Why
not just perform the procedure on an outpatient basis in their existing facility?

[@wendellsu7375]

Love the videos Dr Bricker, but am I the only one that hears the high pitched buzzing sound from a bad microphone? Makes it hard to watch your videos on higher volume

[@ahealthcarez]

Agreed. Gotta fix that.

[@Newlaw289]

Bad for Hospitals;however, potentially good for IRF as we use hospital days for straight Medicare patients.

[@ahealthcarez]

Thank you for sharing your perspective.

[@carlwoesewasright6602]

So when will internists have to unionize to stop salary cuts and at-risk salary, while the surgeons keep making more? Surgeons can own part of the facilities, but internists can't (IE: hospitalists)? Let's be real, almost all internists today are W2 employees and there are less and less feasible options for non-surgeons. CMS is trash.

[@ahealthcarez]

Thank you for watching and sharing your thoughts.